Disease Information for Bullous diabeticorum lesion

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Clinical Manifestations
Signs & Symptoms
Arm/upper extremity skin lesion
Blisters
Bulla/bullous rash
Bulla/normal base/no erythema
Distribution/lower extremity
Erosions
Lesions on Elbows
Lesions on knees
Local lesion/skin rash
Rash/Lesions occur on pressure points/Acral lesions
Subepidermal Blisters
Vesicobullous rashes
Disease Progression
Course/Self limited usually
Demographics & Risk Factors
Established Disease Population
Patient/Diabetes mellitus
Patient/Type I/diabetic (juvenile)
Sex & Age Groups
Population/Female
Diagnostic Test Results
Pathology
BX/Skin Caterpillar lesions/porphyria like
Associated Diseases & Rule outs
Rule Outs
Diabetic foot ulcer
Pemphigus
Associated Disease & Complications
Bullous Diabeticorum lesions
Disease Mechanism & Classification
Class
CLASS/Facial area manifestation/disorder (ex)
CLASS/Dermatologic/Subcutaneous (category)
CLASS/Lower extremity involvement/disorder (ex)
Pathophysiology
Pathophysiology/Implies DM Neuropathy/Neuropathy complications
Process
PROCESS/Metabolic/storage disorder (category)
Definition

Bullous diabeticorum lesions microvascular issue at pressure points-----Jacqueline M Junkins-Hopkins, MD [main author]: Background: Bullosis diabeticorum is a distinct, spontaneous, noninflammatory, blistering condition of acral skin unique to patients with diabetes mellitus; It is also termed bullous disease of diabetes and diabetic bullae;

Pathophysiology: The etiology of bullosis diabeticorum is not known; The role of trauma has been speculated; however, this alone does not explain the often spontaneous development of multiple lesions at several locations; The pathophysiology is likely multifactorial; Many, but not all, patients with this condition have nephropathy or neuropathy; some authors have hypothesized an etiologic association, possibly related to a local, subbasement, membrane-zone, connective-tissue alteration; Hyalinosis of small vessels noted on biopsy specimens has led some authorities to speculate microangiopathy-associated blister induction; Some electron microscopic evidence has suggested an abnormality in anchoring fibrils; A reduced threshold to suction-induced blister formation has been reported; Prominent acral accentuation of these lesions suggests a susceptibility to trauma-induced changes, Bullosis diabeticorum tends to arise in patients with long-standing diabetes mellitus or with multiple complications of the disease. It has been reported to occur in approximately 0.5% of diabetic patients; Patients with uncomplicated or newly diagnosed disease, including type 2 diabetes, also may be affected; Blisters may recur; lesions tend to heal without significant scarring; No significant morbidity is associated with this condition unless secondary infection occurs; One report has described osteomyelitis arising at a site of bullosis diabeticorum; Sex: A male-to-female ratio of 2:1 is reported in the literature. Age: The reported age of onset ranges from 17-84 years; Blisters occur spontaneously and abruptly, often over night, and usually without known antecedent trauma; Lesions tend to be asymptomatic, although mild discomfort or burning has been described; Blisters heal spontaneously within 2-6 weeks of onset; Bullosis diabeticorum manifests as tense, nontender blisters arising on nonerythematous skin; Blisters typically occur on the feet or lower legs , but they also may occur on fingers, toes, hands, and arms; Blisters tend to be large (from 1-17 cm in diameter), often with an irregular shape , simulating a burn; Rarely, nonacral sites (eg, trunk) may be involved; Causes: Prominent acral accentuation of these lesions suggests a susceptibility to trauma-induced changes

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External Links Related to Bullous diabeticorum lesion
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PubMed (National Library of Medicine)
NGC (National Guideline Clearinghouse)
Medscape (eMedicine)
Harrison's Online (accessmedicine)
NEJM (The New England Journal of Medicine)
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