Skin complaints are common in the general population, but they are even more common in patients with diabetes and can range from chronic and frustrating problems to actual emergencies needing immediate aggressive care.
During two Saturday Meet-the-Expert sessions “Skin & Endocrine Disorders: Beyond the Usual,” Michelle Tarbox, MD, FAAD, Assistant Director of Dermatology and Dermatopathology and Assistant Dean of Medical Student Affairs at Texas Tech University Health Sciences Center, will review the range of skin manifestations in diabetic patients and when those conditions warrant additional or immediate concern. The sessions will begin at 2:15 pm and 3:30 pm in Room 17B.
“People who care for patients with diabetes must be able to identify those conditions that indicate something more serious is going on internally. These are what I call the red flag skin conditions,” said Dr. Tarbox. “They also need to be able to accurately recognize and appropriately refer the dermatologic emergencies that can specifically occur in this vulnerable patient population.”
Using a series of case presentations with photo illustration, Dr. Tarbox will take attendees through a number of conditions that diabetic patients are particularly susceptible to including mucormycosis, candidiasis, dermatophyte infections, diabetic dermopathy, diabetic bullae, acanthosis nigricans, and lipoatrophia semicircularis, among others.
“Patients with diabetes have a higher blood glucose level, so there are certain organisms that grow more quickly or aggressively on those patients,” she said. One unusual infection that can become quite serious, constituting a dermatological emergency, is rhizopus infection of the nasal mucosa, called mucormycosis.
“It is caused by a fungal organism that likes to grow on sweet fruits, like strawberries and can actually cause a very severe infection in patients who have diabetes that is out of control. It’s something that needs to need be managed aggressively,” she said.
While mucormycosis is relatively rare, more endocrinologists will see problems with candidiasis or dermatophyte infections, although treatment may need to be more aggressive in diabetic patients because of immune dysfunction and the aggressive growth of bacteria or fungus due to high blood glucose levels or even high insulin levels.
“Some of other things that we see are actually findings of hyperinsulinemia. So not only can the high blood glucose level change the way the skin manifests different conditions, but the high insulin level that can be present, especially in type 2 patients, can cause skin changes because insulin is a growth factor to the skin,” she said.
Dr. Tarbox will also review skin conditions that may provide insight into internal complications as well, such as acanthosis nigricans, which usually manifests a thickening of skin around the neck and in the underarm area. But, she noted, when patients have a severe condition of diabetes, acanthosis nigricans can actually be present all over the body including on the face, on the hands, and sometimes even inside the mouth.
“The important distinguishing factor with that is occasionally when patients present with that extensive acanthosis nigricans they actually have an internal malignancy. So we’ll discuss the steps they need to take to help rule that condition out in those patients,” she said.
Dr. Tarbox will also provide guidance for clinicians to help them better assist their patients with diabetes in managing both expectations and care of those skin conditions that are more chronic and frustrating than dangerous.
“Those are the everyday frustration problems that we can give the patients some guidance as to what to expect or how much improvement they might be able to get. Sometimes it’s important to establish realistic expectations,” she said.