Endocrine Abstracts

Background: The different changes are seen on skin and it’s accessories in patients (pts) with Type 2 Diabetes (T2D); some of them represent the prognostic indicator of complicated diabetes and some directly contribute in development of them. The aim of our study was to examine the prevalence of characteristic changes of skin and its accessories in T2D considering the grade of severity of Diabetic Peripheral Neuropathy (DPN).

Materials and methods: The objective data on foot examination of 195 pts with T2D were analyzed. (Age 38-78 yrs., DD 14.5±9 yrs., male/female 1.5/1). Pts were divided into 4 groups according to the grade of DPN; Gr.1: without DPN; Gr.2: sub clinical DPN; Gr.3: clinical DPN; Gr.4: disabling DPN (classification suggested by Boulton, 1998); the following types of skin humidity were described: normal/smooth skin; dry/flake skin and very dry/rough skin with fissures and keratoses.

Results: Skin humidity, which is the common manifestation of diabetic autonomic injury was related to the severity of DPN, particularly, DPN 2–4 times raises the possibility of dryness of the skin on the foot; the percentile of pts with very dry skin according to the groups were 11%/17%/38%/43%; the risk of callus development was significantly high in case of clinical (63%) and disabling(91%) DPN, the possibility of neuropathy ulcer was also high in Gr4 - 2 out of 7 pts. The high incidence of onychomycosis was noted, especially in Gr.3 (37.4%) and Gr.4(57.1%). The incidence of Yellow nails syndrome was very high – 39.4% of all cases in all groups. The Melin’s shin spots were found in fourth of the patients, mainly in men and it was not related to the severity of DPN; a few cases of rubeosis plantarum and bulbosis diabeticorum were revealed; the cases of necrobiosis were not noted.

Conclusion: The prevalence of the characteristic changes of skin and it’s accessories in Type 2 Diabetes Mellitus is sufficient high; The incidence of dryness of the skin, callosities and onychomycosis is depended on the severity of DPN, and may have a harmful impact on the course of the foot problems and its outcome; by using of their early detection and treatment many problems concerning to diabetic foot may be avoided.