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Skin disorders common in children with type 1 diabetes
Cutaneous manifestations usually develop early in the course of disease.
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Two-thirds of children with type 1 diabetes may have skin disorders, according to the results of a study published in Diabetes Care.
The most common cutaneous manifestation was dry skin, or acquired ichthyosis. Miloš D. Pavlovic, MD, PhD, and colleagues from Belgrade, Serbia, discovered that some disorders are related to disease duration, such as diabetic hand and rubeosis faciei, and some develop early in the course of disease, like acquired ichthyosis and keratosis pilaris.
“Cutaneous manifestations generally appear subsequent to the development of diabetes but may be the first presenting sign or even precede the diagnosis by many years,” the researchers wrote.
Prevalence of disorders
Pavlovic and colleagues assessed the prevalence of cutaneous disorders in 212 patients with type 1 diabetes (aged 2 to 22 years; diabetes duration, one to 15 years). Patients were matched with 196 healthy controls.
“In our study, the type 1 diabetic patient population was younger and had shorter diabetes duration than those described in previous studies, did not have retinopathy and neuropathy, and had a very low prevalence of nephropathy and hypertension,” the researchers wrote.
Overall, 68% of patients with diabetes had at least one cutaneous disorder compared with 26.5% of the controls. Further, 38% had diabetes-associated skin lesions.
Acquired ichthyosis, rubeosis faciei, diabetic hand and necrobiosis lipoidica were more common in patients with diabetes compared with controls (see chart).
“It is clear that the skin dryness is one of the earliest and most common manifestations of type 1 diabetes,” the researchers wrote. They found a “reduced hydration state of the stratum corenum and decreased sebaceous gland activity in patients with diabetes, without any impairment of the stratum corenum barrier function.”
Ten patients (4.7%) with diabetes had fungal infections, compared with 1.5% of patients in the control group. Additionally keratosis pilaris was present in 11.7% of patients with diabetes, compared with 1.5% of patients in the control group.
Researchers noted that the frequency of cutaneous reactions to insulin therapy was low (–2.7%).
Dermatologist for diabetics
“The frequency and type of cutaneous lesions justify the early inclusion of a dermatologist in the management of type 1 diabetic patients in order to recognize and treat the disorders and direct further research into prevention of some of the lesions, especially in those with an underlying fibrosing process,” the researchers wrote.
For more information:
- Pavlovic MD, Milenkovic T, Dinic M, et al. The prevalence of cutaneous manifestations in young patients with type 1 diabetes. Diabetes Care. 2007;30:1964-1967.