1. Skin diseases commonly seen in diabetic patients
Dr. Au Tak Shing
MBBS (HK), MRCP (UK),
FHKCP, FHKAM (Medicine), FRCP (Edin),
Dip Derm (Lond), Dip GUM (LSA),
DCH (Lond), DFM (CUHK),
Specialist in Dermatology and Venereology

2. Skin disease and DM Skin manifestations of DM
Skin disease as side effects of treatment for DM
Treatment of skin disease resulting in DM

3. Dermatophyte infection
Tinea is common in DM patients
May not be more common than general population
Need for treatment is even stronger
Watch out for secondary bacterial infection

4. Infection or not?
Distribution is a very important clue

5. Distribution Fungal infection is usually asymmetrical
Dermatitis is usually symmetrical or corresponding to the primary cause

6. Infection or not? Distribution is a very important clue
Morphology of an individual lesion

7. Candidiasis More common in DM patients Vulvo-vaginitis
Balano-posthitis
Can be the first sign of DM

8. Diabetic dermopathy Quite common
Multiple, asymptomatic, irregularly shaped, discrete, atrophic, brown macules resembling scars
Shins
Intimal thickening and deposition of PAS-positive fibrillary material in vessel walls
Microangiopathy elsewhere

9. Acanthosis nigricans Velvety hyperpigmentation of intertriginous areas
Less often on extensor surfaces
Commonly associated with insulin resistance
Obesity, darkly-pigmented patients

10. Diabetic bullae Bullous diabeticorum
Non-inflammatory bullae on lower extremities
Pathology uncertain

11. Bullous pemphigoid
Autoimmune process that affects the dermo-epidermal junction
Elderly
Multiple intact bullae
Investigation: skin biopsy for histology and immunofluorescence study
Treatment: oral steroid +/- other immuno-suppressants

12. Necrobiosis lipoidica
Yellow atrophic patches often on shins
Erythematous border
Ulceration
Not always associated with DM

13. Disseminated granuloma annulare
Annular lesions composed of papules
Usually smooth surface
Controversy about relation with DM

14. Neuropathic ulcers
Non-painful ulcers at feet
Pressure points

15. Acral dry gangrene
Due to vascular disease

16. Eruptive xanthomas Reddish yellow papules
Developing over weeks to months
Elevated serum triglycerides in patients with poorly controlled DM
Good control of DM leads to resolution

17. Contact
Dr. Au Tak Shing
Unit 502, Hing Wai Building, 36 Queen’s Road Central, HK (tel: )
香港中環皇后大道中36號興瑋大廈5樓502室（星期一、三、五）
Unit 922, Argyle Centre Phase One, 688 Nathan Road, Mongkok (tel: )
九龍旺角彌敦道688號旺角中心第一座9樓922室（星期二、四、六）