eMedicine Specialties > Dermatology > Bullous Diseases

Bullous Disease of Diabetes: Follow-up

Author: Jacqueline M Junkins-Hopkins, MD, Associate Professor, Director, Division of Dermatopathology and Oral Pathology, Department of Dermatology, Johns Hopkins Medical Institutions
Contributor Information and Disclosures

Updated: Jun 24, 2009

Follow-up

Further Outpatient Care

  • Monitor bullous disease of diabetes (bullosis diabeticorum) patients for development of secondary infection.
  • Exclude other blistering dermatoses.
  • Immediately address unroofed blisters, and institute the appropriate wound-healing treatment regimen.

Complications

  • Secondary infection and occasional scarring may occur with bullous disease of diabetes (bullosis diabeticorum).
  • Osteomyelitis reportedly has developed at a site of bullous disease of diabetes (bullosis diabeticorum).
  • The need for amputation due to secondary infection has been reported.

Prognosis

  • The bullous disease of diabetes (bullosis diabeticorum) blisters typically heal spontaneously, within 2-6 weeks, but lesions often recur in the same or a different location.
  • Secondary infection may develop, but the prognosis for bullous disease of diabetes (bullosis diabeticorum) typically is good.

Patient Education

  • For excellent patient education resources, visit eMedicine's Diabetes Center.

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize bullous disease of diabetes (bullosis diabeticorum) may result in the overzealous treatment or systemic evaluations that may be required for similar conditions, such as porphyria or epidermolysis bullosa acquisita.
 


More on Bullous Disease of Diabetes

Overview: Bullous Disease of Diabetes
Differential Diagnoses & Workup: Bullous Disease of Diabetes
Treatment & Medication: Bullous Disease of Diabetes
Follow-up: Bullous Disease of Diabetes
Multimedia: Bullous Disease of Diabetes
References
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References

  1. Kramer DW. Early or warning signs of impending gangrene in diabetes. Med J Rec. 1930;132:338-42.

  2. Rocca FF, Pereyra E. Phlyctenar lesions in the feet of diabetic patients. Diabetes. May-Jun 1963;12:220-2. [Medline].

  3. Cantwell AR Jr, Martz W. Idiopathic bullae in diabetics. Bullosis diabeticorum. Arch Dermatol. Jul 1967;96(1):42-4. [Medline].

  4. Larsen K, Jensen T, Karlsmark T, Holstein PE. Incidence of bullosis diabeticorum--a controversial cause of chronic foot ulceration. Int Wound J. Oct 2008;5(4):591-6. [Medline].

  5. Bernstein JE, Levine LE, Medenica MM, Yung CW, Soltani K. Reduced threshold to suction-induced blister formation in insulin-dependent diabetics. J Am Acad Dermatol. Jun 1983;8(6):790-1. [Medline].

  6. Tunuguntla A, Patel KN, Peiris AN, Zakaria WN. Bullosis diabeticorum associated with osteomyelitis. Tenn Med. Nov 2004;97(11):503-4. [Medline].

  7. Lipsky BA, Baker PD, Ahroni JH. Diabetic bullae: 12 cases of a purportedly rare cutaneous disorder. Int J Dermatol. Mar 2000;39(3):196-200. [Medline].

  8. James WD, Odom RB, Goette DK. Bullous eruption of diabetes mellitus. A case with positive immunofluorescence microscopy findings. Arch Dermatol. Oct 1980;116(10):1191-2. [Medline].

  9. Basarab T, Munn SE, McGrath J, Russell Jones R. Bullosis diabeticorum. A case report and literature review. Clin Exp Dermatol. May 1995;20(3):218-20. [Medline].

  10. Toonstra J. Bullosis diabeticorum. Report of a case with a review of the literature. J Am Acad Dermatol. Nov 1985;13(5 Pt 1):799-805. [Medline].

  11. [Guideline] Bantle JP, Wylie-Rosett J, Albright AL, et al. Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care. Jan 2008;31 Suppl 1:S61-78. [Medline].

  12. [Guideline] American Diabetes Association. Standards of medical care in diabetes. I. Classification and diagnosis. Diabetes Care. Jan 2008;31(Suppl 1):S12-3.

  13. [Guideline] American Diabetes Association. Standards of medical care in diabetes. V. Diabetes care. Diabetes Care. Jan 2008;31(Suppl 1):S16-24.

  14. Bernstein JE, Medenica M, Soltani K, Griem SF. Bullous eruption of diabetes mellitus. Arch Dermatol. Mar 1979;115(3):324-5. [Medline].

  15. Centers for Disease Control and Prevention. National Diabetes Fact Sheet. United States. Atlanta, Ga: Centers for Disease Control and Prevention; 2003:[Full Text].

  16. Goodfield MJ, Millard LG, Harvey L, Jeffcoate WJ. Bullosis diabeticorum. J Am Acad Dermatol. Dec 1986;15(6):1292-4. [Medline].

  17. Phillips P, Weightman W. Diabetes and the skin. Correspondence. Aust Fam Physician. Oct 2005;34(10):48.

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Further Reading

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Keywords

bullous disease of diabetes, bullosis diabeticorum, diabetic bullae, diabetes mellitus, diabetic disease, type 1 diabetes, insulin-dependent diabetes, diabetes complications, uncomplicated diabetes, type 2 diabetes

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Contributor Information and Disclosures

Author

Jacqueline M Junkins-Hopkins, MD, Associate Professor, Director, Division of Dermatopathology and Oral Pathology, Department of Dermatology, Johns Hopkins Medical Institutions
Jacqueline M Junkins-Hopkins, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, and American Society of Dermatopathology
Disclosure: Nothing to disclose.

Medical Editor

Maureen B Poh-Fitzpatrick, MD, Professor Emerita of Dermatology and Special Lecturer, Columbia University; Professor of Medicine (Dermatology), University of Tennessee
Maureen B Poh-Fitzpatrick, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and New York Academy of Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Edward F Chan, MD, Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine
Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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