A New Appraisal of Dermatologic Manifestations of Diabetes Mellitus
Diabetes mellitus is a morbid and costly condition that carries a high burden of disease for patients and society as a whole. In dermatology, a great number of skin findings have been associated with diabetes, some demonstrating a stronger connection than others. Importantly, several cutaneous findings have systemic implications in patients with diabetes that should prompt the dermatologist to evaluate the conditions accordingly and, if necessary, communicate with the patient’s primary care physician and other specialists. This column will explore some of the skin conditions associated with diabetes, examine the strengths of these associations, and discuss some potential underlying pathophysiologic mechanisms to provide dermatology residents with a proper framework for approaching patients with diabetes.
Conclusion
Given the diverse cutaneous manifestations of diabetes, it is important to distinguish those that are directly related to diabetes from those that suggest there may be another underlying process. For example, a new patient presenting to a primary care physician with acanthosis nigricans and yellow nails should immediately trigger a test for a hemoglobin A1c (glycated hemoglobin) level to investigate for diabetes; however, clinicians also should be wary of patients with acanthosis nigricans who report early satiety, as this asso-ciation may be a sign of underlying malignancy. Conversely, the presence of yellow nails in a patient with chronic diabetes should not be ignored. The physician should consider onychomycosis and query the patient about possible respiratory symptoms. In the case of a multisystem disease such as diabetes, it may be challenging to reconcile seemingly disparate skin findings, but having a framework to approach the cutaneous manifestations of diabetes can help to properly identify and treat an individual patient’s afflictions.
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