THE PREVALENCE OF CUTANEOUS MANIFESTATIONS IN IDDM PATIENTS AND THEIRASSOCIATION WITH DIABETES RISK-FACTORS AND MICROVASCULAR COMPLICATIONS

OBJECTIVE - The aim of our study was to evaluate the frequency of skin manifestations, including the diabetic hand syndrome, in young IDDM p atients. In addition, we studied the relation of the cutaneous manifes tations to diabetes duration, glycemic control, and microvascular comp lications. RESEARCH DESIGN AND METHODS - The frequency of skin manifes tations, including the diabetic hand syndrome, were examined in 238 ID DM patients (disease duration > 5 years) and 122 healthy control subje cts in a cross-sectional study. In addition, we studied the relation o f the cutaneous manifestations with diabetes duration, glycemic contro l, BMI, microvascular complications, and stratum corneum hydration usi ng a stepwise logistic regression. RESULTS - Diabetic skin manifestati ons were detected in 168 of 238 (71%) IDDM patients and in 18 of 122 ( 14%) of the control subjects. Ichthyosiform skin changes of the shins, scleroderma-like skin changes, tinea pedis, and dry scaly palms were detected in 48 vs. 7%, 39 vs. 0%, 32 vs. 7%, and 21 vs. 0.8% of the pa tients and control subjects, respectively. In the diabetic patients, a significant association was found between ichthyosis of the shins and scleroderma-like skin changes of the hand (P < 0.001) and between scl eroderma-like skin changes and the skin dryness of the palms (P < 0.00 01). When diabetic risk factors were considered, diabetes duration was significantly associated with scleroderma-like skin changes and ichth yosis of the shins (P < 0.0001). The latter was also found to be relat ed to diabetic retinopathy (P < 0.0001). Keratosis pilaris was present in 21% of the patients versus 9% in control subjects and was found to be exclusively associated with high BMI. CONCLUSIONS - Acquired ichth yosis is a common finding and the most prevalent skin manifestation in young IDDM patients. The development of several skin manifestations i n insulin-dependent patients seems to be related to duration of diabet es and to development of diabetic microvascular complications.