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The Prevalence of Cutaneous Manifestations in Young Patients With Type 1 Diabetes

Milo D. Pavlovi, MD, PHD¹, Tatjana Milenkovi, MD², Miroslav Dini, MD¹, Milan Miovi, MD¹, Dragana Dakovi, DS³, Slaana Todorovi, MD², Zorana akovi, MD⁴, Rado D. Zeevi, MD, PHD¹ and Radoje Doder, MD, PHD⁵

¹ Department of Dermatology, Military Medical Academy, Belgrade, Serbia
² Department of Endocrinology, Mother and Child Healthcare Institute of Serbia "Vukan Èupi," Belgrade, Serbia
³ Department of Dental Medicine, Military Medical Academy, Belgrade, Serbia
⁴ Institute of Dermatovenereology, Clinical Center of Serbia, Belgrade, Serbia
⁵ Department of Gastroenterology, Military Medical Academy, Belgrade, Serbia

Address correspondence and reprint requests to Dr. Milo D. Pavlovi, Dermatology, Military Medical Academy, Crnotravska 17, 11002, Belgrade, Serbia. E-mail: mdpavlovic2004{at}yahoo.com

OBJECTIVE—The aim of the study was to assess the prevalence of cutaneous disorders and their relation to disease duration, metabolic control, and microvascular complications in children and adolescents with type 1 diabetes.

RESEARCH DESIGN AND METHODS—The presence and frequency of skin manifestations were examined and compared in 212 unselected type 1 diabetic patients (aged 2–22 years, diabetes duration 1–15 years) and 196 healthy sex- and age-matched control subjects. Logistic regression was used to analyze the relation of cutaneous disorders with diabetes duration, glycemic control, and microvascular complications.

RESULTS—One hundred forty-two (68%) type 1 diabetic patients had at least one cutaneous disorder vs. 52 (26.5%) control subjects (P < 0.01). Diabetes-associated skin lesions were found in 81 (38%) patients. Acquired ichthyosis, rubeosis faciei, diabetic hand, and necrobiosis lipoidica were seen in 22 vs. 3%, 7.1 vs. 0%, 2.3 vs. 0%, and 2.3 vs. 0% of type 1 diabetic and control subjects, respectively. The frequency of cutaneous reactions to insulin therapy was low (–2.7%). The prevalence of fungal infections in patients and control subjects was 4.7% and 1.5%, respectively. Keratosis pilaris affected 12% of our patients vs. 1.5% of control subjects. Diabetic hand was strongly (odds ratio 1.42 [95% CI 1.11–1.81]; P < 0.001), and rubeosis faciei weakly (1.22 [1.04–1.43]; P = 0.0087), associated with diabetes duration. Significant association was also found between acquired ichthyosis and keratosis pilaris (1.53 [1.09–1.79]; P < 0.001).

CONCLUSIONS—Cutaneous manifestations are common in type 1 diabetic patients, and some of them, like acquired ichthyosis and keratosis pilaris, develop early in the course of the disease. Diabetic hand and rubeosis faciei are related to disease duration.

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