BULLOSIS DIABETICORUM AS THE PRESENTING SYMPTOM OF DIABETES-MELLITUS

This report describes a case of a 52-year-old man who was not known to suffer from diabetes, but presented with large bullae, erosions, and ulcerations involving the shins and feet, accompanied by peripheral er ythema and linear excoriations near the lesions. At that time the pati ent was found to have Type II diabetes mellitus (DM). The diagnosis of bullosis diabeticorum was confirmed by electron microscopy that revea ls subepidermal deposits and can easily be differentiated from bullous pemphigoid where the deposits are higher in the basement membrane. Tr eatment with granuflex dressings to the right shin ulcer, and silver s ulphadiazine dressings to plantar and other lesions, led to improvemen t in the bullae, His blood sugar was controlled with insulin. Six mont hs later the bullae have not returned and he has maintained a high-nor mal level of hemoglobin A(1c). We cannot say if the stress of his hosp italization and/or his infection caused an exacerbation of his Type II DM, or if a worsening of his serum glucose level precipitated formati on of the bullae, Further research is needed to explore the possibilit y that bullosis diabeticorum may be exacerbated by poor control of dia betes or, conversely, that good metabolic control may prevent its outb reak. We recommend that any patient with bullous lesions be screened f or diabetes mellitus. (C) 1997, Editrice Kurtis.