Photoessay: The Skin and Diabetes Mellitus
by A Huntley
Dermatology Online Journal, December 1995
Volume 1, Number
2
Diabetes and Infection
-
candida
malignant external otitis
staph and strep
dermatophyte
candida infection
Candida albicans is a frequent pathogen in the skin of diabetics
usually
involving the groin or genital region. Candida involvement of the groin
region
and uncircumcised penis tend to occur in men who have poor control of
their
diabetes.
-
Figs 35,36. Groin and genital region of 2 patients with diabetes
mellitus
demonstrating candida albicans infection. On the left the groin region
has
erythema and multiple satellite papules, typical for candida infection
of this
region. On the right the patient has erythema of the glans penis which
is
positive by potassium hydroxide examination for yeast.
The hands may also become involved with Candida. Usual sites of
infection
include proximal nail fold and intertriginous areas which allow for
natural
moisture to accumulate. The finger web-space can serve as a moist
area, and may
be the site of acute candida infection.
-
Fig 37. The web space between the third and fourth fingers on the
left hand
of this patient with diabetes mellitus demonstrates erythema covered
with a
white curd-like material. A scraping of this material is positive for
pseudohyphae on potassium hydroxide examination.
malignant external otitis
External otitis is a common enough diagnosis in the general population
in
general, however in diabetics it may become a serious problem. The
patient
complains of severe ear pain from the otitis. The infection, due to
Pseudomonas, may dissect along fascial planes and even gain
access to
cranial nerves. Examination of the ear canal reveals polypoid growths.
This
infection has a mortality rate of about fifty percent.
-
Fig 38. Otoscopic view of Pseudomonas external otitis in an elderly
diabetic
patient. The polyp which is a characteristic feature of malignant
external
otitis, is clearly visualized on the upper right wall.
staph and strep
Staphylococcus infection does not statistically account for
more loss
of work by diabetic employees. However, it seems that some of the more
severe
infections encountered are in disabled patients.
-
Fig 39. Abscess involving the left arm of a diabetic patient. This
patient
developed a carbuncle at the site of insulin injection.
-
Fig 40. This patient has an ankle ulcer which developed an
erythematous halo
and a red streak going up the leg. This vascular ulcer is complicated
by
cellulitis and lymphangitis.
-
Fig 41. First finger of a middle aged diabetic patient who complains
of pain
. The patient has acute bacterial paronychia accompanied by
lymphangitis.
dermatophyte infection
There are conflicting reports about an increased prevalence of
dermatophyte
infection in diabetics. For the population we evaluated, the
prevalence was not
increased.
-
Fig 42. Dorsum of the left hand in a 25 year old diabetic student
demonstrating an annular erythematous scaling plaque of dermatophyte
infection.
All contents copyright (C), 1995.
Dermatology Online Journal
University of California Davis
