Diabetides

DIABETIDES, a term introduced by A. Fournier to designate skin lesions associated with the presence of hyperglycemia (sometimes along with hypercholesterolemia). Pathogenetically, diabetides arise 1) from a general metabolic disturbance without the participation of microbes (proof is their disappearance upon general treatment); 2) from an increased susceptibility of the skin of diabetics to infections—pyogenic and putrefactive (proof is experiments with the introduction of a sugar solution subcutaneously or into the peritoneum of rabbits, which makes their skin susceptible to experimental pyoderma); 3) from local irritation of the skin by sugar-containing secretions, especially urine; the resulting dermatitis of the intertrigo type is complicated by infection with yeast cells, streptococci, dermatophytes of epidermophytosis or trichophytosis, etc.—Clinically, the following are especially characteristic of diabetides: 1) diabetic balanoposthitis, chronic in course, of the intertriginose type, leading to wrinkling and atrophy of the skin of the prepuce with a state of phimosis (see Balanitis and balanoposthitis); 2) diabetic eczema of the external genitalia, femorocrural folds, internal surface of the thighs, and pubis in women in the form of itchy, bright-red, moist disks with scalloped outlines and thick impetiginose scale-crusts; 3) gangrena bullo-serpiginosa (Kaposi), beginning with a phlyctena that grows peripherally and yields a central scab that separates spontaneously; usual localization is the limbs; the disks are frequently multiple; 4) stubborn disseminated furunculosis, less often carbunculosis; 5) diabetic xanthoma; 6) stubborn recurrent epidermophytosis of the interdigital folds on the feet.—Frequent among diabetics and those with glycosuria are: a) essential pruritus, either general or local, especially of the genitals, b) diabetic prurigo, c) various types of eczema. According to Greenwood and others, diabetics are prone to psoriasis, erysipelas, and Dupuytren's contracture. According to Greenwood, obese diabetics with dry skin are especially predisposed to dermatoses. A special place is occupied by so-called diabetic gangrenes, sometimes dry, sometimes moist, sometimes total and deep, sometimes partial and superficial. They arise either primarily (usually the mummification type) or secondarily following trauma, boils, phlegmon, etc. Affecting mainly the lower extremities, they are caused, according to Labbé, by a) purulent-putrefactive infection, b) neuritis from syphilis, alcoholism, perhaps from hyperglycemia, c) obliteration of arteries of the spontaneous gangrene type.