Diabetes combined with skin lesions is one of the most common complications of diabetes. It is characterized by a wide range and variety of lesions that damage the skin in any part of the body and occur in all periods of diabetes. It has been reported abroad that about 30% of diabetic patients have combined skin damage. Skin lesions can aggravate the condition of diabetes and lead to very serious consequences. Therefore, it is very important to actively control diabetes and reduce the incidence of skin disease to improve the quality of life of diabetic patients.
There are many types of diabetic skin lesions, which can be clinically categorized into the following five types: skin lesions caused by microvascular disorders; skin lesions caused by nerve damage; skin lesions caused by metabolic disorders; diabetic skin infections and skin reactions to glucose-lowering drugs. The pathogenesis of most diabetic skin lesions is not well understood. The following is a discussion of common skin conditions and their treatment.
Skin lesions due to vascular disorders
1, diabetic skin flushing: mostly seen in middle-aged male patients or above. The flushing of the face, or the appearance of well-defined rose-colored erythema on the hands, feet and calves, is commonly seen in severe acidosis. Some patients with mild or recessive diabetes may also see facial flushing without fever. This is due to decreased vascular elasticity of the skin, tissue hypoxia, and microvascular dilation. Active treatment of diabetes can improve the symptoms without special treatment.
2, diabetic local ischemia: common smooth plantar skin, thinning and brightening; hair loss, toenail atrophy; burning pain in the foot, especially at night, the pain increases when exposed to heat or strenuous exercise; with intermittent claudication, pale skin color when the calf is raised, the foot artery pulsation disappears; due to local ischemia for a long time, can form ischemic ulcers, and prone to bacterial infection, the formation of wet or dry gangrene in the foot for a long time In addition to the active treatment of diabetes mellitus, it is important to treat the condition according to the specific circumstances. In addition to active treatment of diabetes, according to the specific situation, anti-infection, removal of necrotic tissue, topical drugs, etc.. In addition to the active treatment of diabetes, anti-infection, removal of necrotic tissues, topical medications, etc. with Chinese herbal medicine to warm the meridians and disperse cold, activate blood circulation, such as, Yanghe Tang, Angelica Siwei Tang, etc.
3, purpura: seen in the lower limbs of the elderly. Purpura is usually 1-2mm bleeding spots, which do not fade when pressed, more in number, gathered on the inner or outer edge of the foot, also seen on the lower leg. After fading, it leaves temporary hyperpigmentation spots. While actively treating diabetes, use some drugs to stop bleeding and reduce vascular permeability, such as vitamin C, rutin, calcium gluconate, etc. Chinese medicine is used to strengthen the spleen and unify the blood, such as Guixin Tang.
4.Erythema like dermatitis: It occurs in the calf or foot and is a red spot with clear border, not accompanied by fever, increased blood sedimentation, increased or normal white blood cell count. Active treatment of diabetes mellitus, no special treatment is needed.
5, diabetic blister: sudden onset, mostly in the extremities appear similar to the tension of burns blister, no inflammatory reaction around, 0.5-10cm size, thin transparent wall, local non-itchy and non-painful, 2-5 weeks to heal, no scar after healing, this blister is more common. Occasionally, they are blood blisters, with scarring after healing, and are prone to recurrence. Active treatment of diabetes mellitus is accompanied by symptomatic treatment to avoid secondary infection. Generally, after local skin disinfection of the large blisters, the herpes fluid is extracted with a needle, and then topical application of zinc oxide oil with safranin, followed by wet application of 0.02% furacilin solution. The blisters dry up and crust over within a few days, avoiding treatment with adrenaline corticosteroids.
6.Pigmented spots on the front of the shins: common in men. Often in the front of both shins appear erythematous, papular, small rash, varying in number, clustered or scattered distribution. It develops slowly and finally forms atrophic spots or hyperpigmentation, without conscious symptoms. No special treatment is needed.
7, diabetic progressive necrosis of lipid-like substance: mostly seen in women, can occur at any age. It is mainly seen in the front of the shin of the lower leg, the outer ankle, but can also occur in other parts. Initially, the lesions are shiny papules of 2 mm in diameter with clear borders that do not recede when pressed; they gradually fuse into yellow round or oval hard plaques of varying sizes with purple margins and yellow central depressions and shiny epidermis that are hard to the touch. The surface of advanced lesions may be scaly and even centrally atrophic. The lesions are often one or several in number and develop progressively, occasionally remaining stationary for a period of time. Treatment of diabetes mellitus is combined with pentoxifylline and aspirin for 3-4 months. For skin lesions, combine with vitamin E orally. The number of skin lesions is small and can be treated with local closure, or topical corticosteroid creams. Chinese herbal medicine is used to clear heat and dampness, remove blood stasis and stop bleeding, with gentian diarrhea liver soup and dioscorea thinning dampness soup.
Skin diseases caused by neurovascular abnormalities
1, diabetic foot: caused by vascular complications and motor, sensory and autonomic neuropathy. Autonomic neuropathy makes the skin dry, less elastic, skin fissures, and bacteria easily invade, forming cellulitis or deep tissue infection. Sensory nerve disorders cause abnormal skin sensation, numbness and cold pain, and even loss of pain sensation. In severe cases, foot ulcers and gangrene are formed. Treatment is the same as diabetic local ischemia. If necessary, ask for a surgical consultation and amputation treatment.
2, diabetic anhidrosis: due to autonomic nerve dysfunction, sweat glands and capillaries appear functional disorders, resulting in dry skin without sweat. There is no special treatment for anhidrosis, it can be treated symptomatically with topical oil ointment to avoid skin fissures. For hyperhidrosis, Chinese herbal medicine can be used, such as Zhi Bai Di Huang Wan, Liu Wei Di Huang Wan, Yu Ping Feng San, and Ginseng Qi Wu Wei Zi Tablets.
Skin lesions caused by metabolic disorders
1, diabetic xanthomas: mostly seen in middle-aged male patients. There are orange papules or nodules at the elbow and knee extensions, buttocks and trunk, of different sizes and hard texture, clustered or scattered distribution, and there may be mild inflammation around the nodules. The rash is usually asymptomatic and chronic. When diabetes is controlled, the rash decreases or disappears, but when the disease worsens, it can recur. This is due to a decrease in lipoprotein esterase activity, resulting in subcutaneous deposition of triglycerides in the serum. Diabetes mellitus should be controlled and niacin should be given orally.
2. Lid xanthoma: Most often seen in middle-aged and older patients. It is a symmetrical, round yellow plaque on the inner side of the upper eyelid, slightly elevated, well-defined, and not easily disappearing. There are no conscious symptoms. It is generally thought to be related to increased cholesterol in the blood, but there are also patients with normal cholesterol. Surgical treatment.
3. Disseminated granuloma annulare: Mostly seen in patients aged 30-70 years. In exposed areas such as the back of the hands and feet, ear shell, neck and upper back of the chest, small papules with a hard texture appear, arranged in a ring shape, with a central depression and a surrounding elevation, with a clear outer edge and a slightly sloping inner edge, ivory-white in color, without conscious symptoms. It is believed that systemic application of corticosteroids is effective, but is prone to recurrence.
4.Carotene deposition: Due to the consumption of food containing more carotene, or due to the decrease of the liver’s ability to compensate for its metabolism, the transformation of carotene to vitamin A is incomplete or insufficient, so that the carotene content in the blood is increased, and the excess carotene is secreted from the sebum, absorbed by the stratum corneum, and deposited in the parts with more cortex, such as the nose, forehead, behind the ears, etc. The skin is yellow. It is also deposited in the parts with thicker stratum corneum, such as the palms of hands and feet, and the skin is orange. In severe cases, the skin of the whole body is yellow. No self-conscious symptoms and normal sclera color. Control diabetes, limit the consumption of food containing more carotene, no special treatment is needed, the prognosis is good.
5. Diabetic sclerosis: Most often seen in middle-aged or older obese diabetic patients. The skin of the neck, upper back, shoulders and face is non-depressed edematous sclerosis, light red or pale, with a shiny surface and a long remission period (different from the sclerosis of streptococcal infection, which recedes within a short period of time). Local lesions are injected with hyaluronidase, fibrinolytic enzymes, corticosteroids, etc. Chinese herbal medicine is used to activate blood circulation and remove blood stasis, and to soften and disperse nodules.
6, waxy skin and joint stiffness: joint stiffness, restricted movement, in which about one-third of patients have taut waxy skin on the back of the hand. Control diabetes. Can reduce the symptoms.
7, pruritus: nearly 40% of diabetic patients. Due to the patient’s reduced autonomic function, and reduced sweating, dry and itchy skin, or due to neurological reactivity caused by itchy skin. Whole body itching. Available antihistamines, such as Benadryl, Keminergy, etc.; local itching can be topical antipruritic agents, stubborn, can be local closed treatment. Chinese medicine should be given to nourish blood and dispel wind, to remove wind and relieve itching, such as eliminating wind.
Diabetes and skin infections
1, purulent bacterial infection: the incidence of diabetes complicating purulent bacterial infection is 8%-20%, mainly Staphylococcus aureus infection, causing boils, carbuncles, folliculitis, sweat glanditis, cellulitis, papillary dermatitis of the head, etc. Severe cases. It can aggravate diabetes and even induce ketoacidosis.
Factors that make diabetic patients susceptible to infection: diabetic patients are dehydrated, affecting the function of multinucleated leukocytes; diabetes and infection, increasing the resistance of surrounding tissues to insulin; high blood glucose concentration, which is conducive to the reproduction and growth of some bacteria; low defense function of the immune system; due to neurological dysfunction, sensory dullness, easy to suffer damage and not easily detected, coupled with impaired blood circulation, tissue hypoxia, so that the ability of the tissue to resist infection The hypoxic tissue is conducive to the growth of anaerobic bacteria.
For treatment, effective control of diabetes mellitus, static or topical antibiotics, surgical treatment if necessary, incision and drainage of pus. Chinese medicine to clear the heat and detoxification treatment, such as the formula of Huanglian detoxification soup, Wu Wei disinfection drink, Qing Dai San, etc.
2, fungal infections: diabetic patients with fungal infections can be up to 40-57%, and not easy to completely cure, easy to relapse. The most common is Candida albicans infection, such as female vaginitis, glansitis, orchitis, nail fungus, etc., manifested as erythema, erosion, scaling, crusting, itching; followed by superficial skin fungal infections, such as ringworm, ringworm, fingernail ringworm, etc.; once again, red ringworm, yellowish or light brown spots in the armpits and the inner side of the femur, round or irregularly shaped, with clear borders, mild scaling, and later pigmentation. You can use topical gentian violet solution, mycoplasma ointment, suppositories, or, in a wide range, oral mycoplasma or ketoconazole, such as ringworm, ringworm of the hands and feet, and ringworm of the fingernails can be treated with topical dacrynic.
Skin reactions due to glucose-lowering drugs
Skin reactions due to commonly used hypoglycemic drugs: such as insulin, sulfonylureas, and biguanides, occur in about 10-55.8% of cases. The reactions are local allergic reactions and systemic allergic reactions. Local allergic reactions such as insulin treatment 1-2 weeks later, the injection site burning sensation, itching, later erythema, hard nodules, a long time local subcutaneous fat atrophy, skin depression or fat hypertrophy. Acute urticaria and angioedema are common in systemic allergic reactions, followed by scarlet fever-like erythema, measles-like erythema, thrombocytopenic purpura, etc. Severe cases may lead to exfoliative dermatitis, herpetic epidermal necrolysis loosening disease, and also occasional anaphylactic shock, which can be life-threatening.
Treatment: for local allergic reactions, the site must be changed when injecting insulin; for mild cases, oral or intramuscular injection of antihistamine preparations, such as fenugreek, benadryl, ketaminergic, etc.; for measles-like erythema or scarlet fever-like erythema, with rash all over the body and accompanied by fever, hydrocortisone intravenous drip or dexamethasone intravenous drip; for severe types of drug rashes such as exfoliative dermatitis, toxic epidermolysis bullosa, etc. Increase the amount of hormone. In addition, strengthen the supportive therapy, the input of whole blood, plasma, albumin, etc., to increase the systemic resistance. Depending on the rash, topical medications should be used.