Bullosis diabeticorum and gustatory sweating: uncommon complications of diabetes

Our goal when managing diabetes is not only to optimize glycemic control but also to minimize the risk of complications. The two go hand in hand — optimize glycemic control and the risk of complications is diminished.

Recently I saw two patients with uncommon complications of the disease — one of which, bullosis diabeticorum, I had not previously seen. This is the seemingly spontaneous eruption of large blisters, usually on the feet and legs. They looked indistinguishable from any other blister although they were quite numerous involving three toes on the left and two on the right with four other blisters on the feet. They were not painful and there was no surrounding inflammation. The etiology is unclear and the management straightforward — do not burst the blisters since doing so apparently increases the likelihood of superimposed infection. My patient fortunately had no involvement on the soles of her feet so she could still get around and come in and be examined. I had no idea what I was dealing with and arranged for a podiatrist to see her that morning. Once seen, this complication will not be forgotten.

Gustatory sweating is more common and far more troubling to the patient. It appears to be a manifestation of autonomic neuropathy and usually keeps company with peripheral neuropathy as well. It the sensation of profuse sweating on the head and neck, upper back and chest within minutes of beginning to eat. This is similar to Frey’s syndrome but the distribution of the sweating is greater. As far as I can gather there is no uniformly accepted preferred mode of therapy but management initially is with anticholinergic therapy.