Cutaneous manifestations of diabetes mellitus

Cutaneous involvement is common in diabetes, with approximately 30% of patients experiencing some dermatological problem during the course of their illness. Skin manifestations may be the first presenting sign of diabetes or even precede the diagnosis by many years, but they generally appear during the course of the disease in patients known to have diabetes. The involvement of skin can be autoimmune in nature, such as necrobiosis lipoidica, acanthosis nigricans, scleredema, diabetic dermopathy, granuloma annulare or infectious like erythrasma, necrotizing fasciitis, and mucormycosis. Pharmacologic management of diabetes, in addition, can also result in skin changes, such as lipoatrophy and lipohypertrophy, at the site of injection of insulin, and oral antidiabetic agents can cause multiple skin reactions as adverse effects. The management of these cutaneous manifestations is modified depending upon the underlying pathophysiology, but a tight control of blood sugar is a prerequisite in all treatment approaches.