Endocrine Abstracts

Introduction

Skin damage is common in diabetes. They can be classified into three groups: dermatoses associated with diabetes, acute and chronic skin complications of diabetes and dermatoses associated with antidiabetic treatments. Bullosis in diabetics, also called Bullosis diabeticorum, is one of the cutaneous complications of diabetes. It is a rare bullous dermatosis particular by its exclusive occurrence in diabetics.

Observation

We report the case of a 73-year-old patient. In his history, there was high blood pressure and type 2 diabetes for 26 years complicated by peripheral neuropathy. He had complained of tense blisters which had started suddenly and spontaneously for 05 days. These lesions were non-painful and non-itchy. There was no history of photosensitivity and the patient could not recall any new drug intake. Clinical examination revealed multiple tense bubbles of serous content on a nonerythematous base was ween on the anterior surface of both legs. Complete blood count and electrolyte test were within normal limits. Serum creatinine was 71 µmol/l, CRP 9 mg/l, and HbA1c 7.1%. Histopathology of the lesional skin showed a subepidermal bulla without any inflammatory infiltrate. A direct immunofluorescence test was negative. Local care after removal of bubbles was indicated. The bubbles healed spontaneously after three weeks, without recurrence with a follow-up of 11 months.

Discussion-conclusion

Diabetic bullosis is characterized by the sudden onset of large, tight bubbles with clear or hemorrhagic content, in healthy skin, without pain, pruritus, inflammation or mucosal damage. It predominates on the soles and the toes. The pathophysiology is poorly understood and would involve vascular alterations, mechanical and /or trophic abnormalities related to the underlying neuropathy. The main differential diagnosis is bullous pemphigoid. The treatment is symptomatic with a spontaneously favorable outcome over a few weeks. This evolution constitutes a key element for the diagnosis.