Diabetic Bullous Disease

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Basics ⬇

Lesions tend to arise in patients with long-standing diabetes mellitus who have multiple complications of the disease.

Clinical Manifestations ⬆ ⬇

Diabetic bullous disease (bullosis diabeticorum) manifests as large, tense, subepidermal, noninflammatory blisters (Fig. 34.3).
Lesions most often arise spontaneously on the lower extremities, especially the ankles and feet. Multiple lesions may develop.
Bullae are asymptomatic unless secondarily infected.

Diagnosis ⬆

Usually made on clinical appearance and by the exclusion of other diagnostic possibilities.

Differential Diagnosis

Bullous Pemphigoid

Biopsy demonstrates subepidermal bullae.
Positive direct and/or indirect immunofluorescence of skin biopsy.

Edema Bullae (also Known as “Hydrostatic Bulla” and “Stasis Blister”)

Develop in patients with an acute exacerbation of chronic edema, particularly of the lower extremities, and in the setting of anasarca.

Management

Blisters generally heal spontaneously within 2 to 6 weeks of onset.
Topical antibiotics are recommended until the lesions heal.