Tuesday , July 17 2018
Home / Resources / Clinical Gems / Handbook of Diabetes, 4th Ed., Excerpt #23: Skin and Connective Disorders in Diabetes

Handbook of Diabetes, 4th Ed., Excerpt #23: Skin and Connective Disorders in Diabetes

Dec 22, 2014

Acanthosis nigricans is associated with numerous condi­tions, including obesity, type 2 diabetes, polycystic ovary syndrome and insulinoma. It is a hyperpigmented velvety overgrowth of the epidermis, which usually occurs in the flexural areas of the axilla, groin and neck (Figure 24.9). Increased circulating insulin levels act via insulin-like growth factor-1 (IGF-1) receptors in the skin to stimulate growth.

Various other skin problems are associated with longstanding diabetes, but are not specific to diabetes. These include bacterial infections (e.g. boils and sepsis caused by Staphylococcus aureus), Candida albicans infections (e.g. vul­vovaginitis, balanitis, intertrigo and chronic paronychia) and tinea (dermatophyte fungal infections) (Figure 24.10). Note also the occurrence of neuropathic and ischaemic foot ulcers in diabetes (see Chapter 21), and the dry skin caused by decreased sweating with autonomic neuropathy.

Chronic paronychia presents with swelling and erythema around the nailfolds, with a discharge (Figure 24.11). Severe involvement may produce onycholysis. Treatment is by keeping the fingers dry and the use of antifungal drugs; systemic drugs such as terbinafine, as well as topical medica­tions, may be necessary.

For more information and to purchase this book, just follow this link:


Rudy Bilous MD, FRCP, Professor of Clinical Medicine, Newcastle University, Honorary Consultant Endocrinologist, South Tees Foundation Trust, Middlesbrough, UK Richard Donnelly MD, PHD, FRCP, FRACP, Head, School of Graduate Entry Medicine and Health, University of Nottingham, Honorary Consultant Physician, Derby Hospitals NHS Foundation Trust, Derby, UK

A John Wiley & Sons, Ltd., Publication This edition first published 2010, © 2010 by Rudy Bilous and Richard Donnelly. Previous editions: 1992, 1999, 2004

Note: The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting a specific method, diagnosis, or treatment by physicians for any particular patient. The publisher and the authors make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particular purpose. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. Readers should consult with a specialist where appropriate. The fact that an organisation or website is referred to in this work as a citation and/or a potential source of further information does not mean that the authors or the publisher endorse the information the organisation or website may provide or recommendations it may make. Further, readers should be aware that Internet websites listed in this work may have changed or disappeared between when this work was written and when it is read. No warranty may be created or extended by any promotional statements for this work. Neither the publisher nor the authors shall be liable for any damages arising herefrom.