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Bullous Disease of Diabetes Treatment & Management

  • Author: Maureen B Poh-Fitzpatrick, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Aug 24, 2015
 

Approach Considerations

Specific treatment of bullous disease of diabetes (bullosis diabeticorum) is unnecessary because the condition is self-limiting. The blister should be left intact whenever possible to serve as a sterile dressing and to avoid secondary infection.

Drug therapy (ie, antibiotics) is only warranted when secondary staphylococcal infection is present.

To see complete information on Diabetic Ulcers, please go to the main article by clicking here .

Helpful guidelines from the American Diabetes Association related to the management of diabetes are as follows:

To see complete information on Diabetes Mellitus, Type 1, please go to the main article by clicking here.

To see complete information on Diabetes Mellitus, Type 2, please go to the main article by clicking here.

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Aspiration and Debridement

Aspiration of fluid from bullous disease of diabetes lesions with sterile technique using a small-bore needle may prevent accidental rupture. Immobilization may prevent damage to the blister. Secondary tissue necrosis may necessitate debridement and possible tissue grafting.

Aggressive wound healing intervention, as enacted with diabetic ulcers, is critical, should the blister become unroofed.

To see complete information on Diabetic Foot, please go to the main article by clicking here.

To see complete information on Diabetic Foot Infections, please go to the main article by clicking here.

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Long Term Monitoring

Patients with confirmed bullous disease of diabetes should be monitored for development of secondary infection until lesions heal entirely.

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Contributor Information and Disclosures
Author

Maureen B Poh-Fitzpatrick, MD Professor Emerita of Dermatology and Special Lecturer, Columbia University College of Physicians and Surgeons

Maureen B Poh-Fitzpatrick, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, New York Dermatological Society

Disclosure: Nothing to disclose.

Coauthor(s)

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, American Society of Dermatopathology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

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.

Michael J Wells, MD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

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.

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

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

  4. 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. 1983 Jun. 8(6):790-1. [Medline].

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

  6. Wilson TC, Snyder RJ, Southerland CC. Bullosis diabeticorum: is there a correlation between hyperglycemia and this symptomatology?. Wounds. 2012 Dec. 24 (12):350-5. [Medline].

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

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

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  12. [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. 2008 Jan. 31 Suppl 1:S61-78. [Medline].

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

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

  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. 1986 Dec. 15(6):1292-4. [Medline].

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

  18. Scheinfeld N. A review and report of blistering distal dactylitis due to Staphylococcus aureus in two HIV-positive men. Dermatol Online J. 2007 May 1. 13(2):8. [Medline]. [Full Text].

  19. Zhang AJ, Garret M, Miller S. Bullosis diabeticorum: case report and review. N Z Med J. 2013 Mar 15. 126 (1371):91-4. [Medline].

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Tense noninflammatory bulla on the leg.
Unroofed blister on the leg. Note the irregular shape.
Histology of bullosis diabeticorum showing a noninflammatory blister with a subepidermal and focally intraepidermal separation (hematoxylin and eosin stain).
High-power view of the dermis beneath the blister showing capillary wall thickening (hematoxylin and eosin stain).
 
 
 
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