Blisters on an elderly woman’s toes
Our patient had already been hospitalized out of concern for cellulitis. Her history and lab work proved the cause to be far more benign.
Making the diagnosis
A diagnosis of bullosis diabeticorum can be made when biopsy with immunofluorescence excludes other histologically similar entities such as EB, noninflammatory bullous pemphigoid, and porphyria cutanea tarda. And while immunofluorescence findings are typically negative, elevated levels of immunoglobulin M and C3 have, on occasion, been reported.5,6 Cultures are warranted only if a secondary infection is suspected.
Treatment is usually unnecessary
The bullae of this condition spontaneously resolve over several weeks without treatment, but tend to recur. The lesions typically heal without significant scarring, although they may have a darker pigmentation after the first occurrence.4 Treatment may be warranted if a patient develops a secondary infection.
In our patient’s case…The bullae resolved within 2 weeks without treatment, although mild hyperpigmentation remained.
CORRESPONDENCE
Lisa Mims, MD, Department of Family Medicine, Medical University of South Carolina, 5 Charleston Center Drive, Suite 263, MSC 192, Charleston, SC 29425; durham@musc.edu
