Bullosis diabeticorum is a sudden blistering of the skin unique to patients with diabetes. It usually affects people between the ages of 17-84, and men are twice as likely as women to suffer from it. The cause of the disease is unknown. These lesions usually appear on the feet and toes, but occasionally on the hands and fingers. They are usually 0.5 to several centimetres in size, and contain a clear, sterile, viscous fluid.
There are two kinds of lesions. Intra-epidermal bullae are clear, sterile, non-haemorrhagic blisters that generally heal on their own within 2-5 weeks without scarring or atrophy. This type of bullae is more common in men with good circulation to the involved extremity (Bolognia and Braverman, 1998). Sub-epidermal bullae are the least common of the two types of bullosis diabeticorum (Huntley, 1982). These blisters are similar to the intra-epidermal blisters except they are occasionally subject to hemorrhage, and may heal with scarring and atrophy.
Bullosis diabeticorum is usually self-limiting; however, bacterial infections can result in deep infections (Huntley, 1982). Many, but not all, patients with this condition have nephropathy (any kidney disease) or neuropathy (any disease of the nervous system.) Bullosis diabeticorum tends to occur in patients with long-standing diabetes mellitus or with multiple complications of the disease. It has been reported to occur in approximately 0.5% of people with diabetes. Patients with uncomplicated or newly diagnosed diabetes also may be affected. Blisters may recur; lesions tend to heal without significant scarring. No significant morbidity is associated with this condition unless secondary infection occurs. One report has described inflammation of the bone and bone marrow arising at a site of bullosis diabeticorum. Local care to avoid blister eruption and appropriate antibiotic treatment for secondary infection is recommended.
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Gone are the days of repelling Mission Impossible-like from the hospital ceiling to retrieve Charlie's medical files before the CDE entered our exam room. It's not that I don't care anymore about his A1c. Of course I care. Maybe in the past I was more consumed by it. For a very long time I so desperately wanted to see an A1c below 8. Now that we've been comfortably in the low to mid-7s for the last couple of years, there's just an expectation. It's become a little anticlimactic....