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. For recurrent lower limb bullous diabeticorum, successful treatment with autologous bone marrow mesenchymal cell transplantation therapy has been reported. [23]
See Diabetic Ulcers, Type 1 Diabetes Mellitus, and Type 2 Diabetes Mellitus for more information.
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. Patients with confirmed bullous disease of diabetes should be monitored for development of secondary infection until lesions heal entirely.
See Diabetic Foot Infections for more information on this topic.
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Bullous disease of diabetes (bullosis diabeticorum). Tense noninflammatory bulla on the leg.
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Bullous disease of diabetes (bullosis diabeticorum). Unroofed blister on the leg. Note the irregular shape.
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Bullous disease of diabetes (bullosis diabeticorum). Histology of bullosis diabeticorum showing a noninflammatory blister with a subepidermal and focally intraepidermal separation (hematoxylin and eosin stain).
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Bullous disease of diabetes (bullosis diabeticorum). High-power view of the dermis beneath the blister showing capillary wall thickening (hematoxylin and eosin stain).
