as most of the dm - specific cutaneous disorders are related to the duration of diabetes and chronic hyperglycemia , a study of cutaneous disorders in patients attending diabetic clinic was undertaken to know the impact of control of diabetes on the pattern of these disorders .
a cross - sectional descriptive study of 500 consecutive patients attending diabetic clinic was conducted in a tertiary care hospital .
patients who had not registered in diabetic clinic , either attending the dermatology clinic directly or referred from wards , were excluded from the study to ensure the uniformity in diabetes care received in diabetic clinic .
a detailed history regarding age , gender , duration of dm , type of diabetes , and treatment taken for diabetes was taken .
complete hemogram , urine analysis , fasting and postprandial plasma sugar tests were done in all the patients .
serum creatinine , serum lipid profile , and fundus examination were also done to detect diabetic complications .
the former was further divided into four categories : dermatoses with known pathogenesis , dermatoses without known pathogenesis , dermatoses that occur with increased frequency , and dermatoses due to diabetic treatment .
the first two categories were correlated with gender , fasting plasma glucose ( fpg ) , duration of diabetes , and complications of diabetes like retinopathy , nephropathy , and peripheral neuropathy .
test and chi - square test with 5% confidence interval ( p value 0.05 ) .
males and females constituted 57.2% ( 286/500 ) and 42.8% ( 214/500 ) of cases with mean age of 58.211.96 and 53.310.78 years , respectively .
the mean duration of dm was 5.55.8 years . in 82% of patients , the duration of diabetes was < 10 years .
the mean fpg was 129.9748.65 mg / dl . in 60% of patients , fpg was < 130 mg / dl and it was 130 - 140 mg / dl in 12% of patients .
general characteristics of diabetic patients with or without specific cutaneous disorders are compared in table 1 .
systemic diseases such as hypertension ( 1.8% ) , ischemic heart disease ( 1% ) , and stroke ( 0.4% ) were present in 16 ( 3.2% ) patients .
retinopathy was present in 14 ( 2.8% ) , nephropathy in 11 ( 2.2% ) , and peripheral neuropathy in 268 ( 53.6% ) patients .
general characteristics of diabetic patients with or without specific cutaneous disorders among specific dermatoses with known pathogenesis , infections and signs of insulin resistance were common [ table 2 ] . among the fungal infections , tinea cruris was common ( 37.68% ) , followed by tinea corporis ( 18.84% ) , pityriasis versicolor ( 15.94% ) , candidal intertrigo ( 13.04% ) , tinea unguium ( 11.59% ) , candidal balanoposthitis ( 8.69% ) , candidal vulvovaginitis ( 4.34% ) , tinea pedis ( 1.4% ) , and tinea barbae ( 1.4% ) . among the bacterial infections ,
furuncles were present in 70.58% , folliculitis in 17.64% , and ecthyma gangrenosum , erysipelas , carbuncle , and cellulitis each in 2.94% of patients .
dermatoses with known pathogenesis among the specific dermatoses without known pathogenesis , bullous diabeticorum was present in two ( 0.4% ) patients , and generalized granuloma annulare and diabetic dermopathy in one ( 0.2% ) patient each . among dermatoses that occur with increased frequency , vitiligo was present in eight ( 1.6% ) , lichen planus in nine ( 1.8% ) and psoriasis in three ( 0.6% ) patients .
local insulin reaction such as erythema and induration was seen in four ( 6.2% ) patients , and nine ( 14.0% ) patients showed insulin lipodystrophy . apart from specific cutaneous disorders ,
various cutaneous disorders are related to diabetic complications such as microangiopathy ( diabetic dermopathy ) , glycosylation of proteins ( diabetic thick skin ) , neuropathy ( diabetic foot ) , immunologic dysfunction ( infections ) , insulin resistance ( acanthosis nigricans ) , and abnormal lipid metabolism ( xanthoma ) .
fasting hyperglycemia is a main contributor to the overall diurnal hyperglycemia in poorly controlled diabetes .
the results ( fpg<130 mg / dl ) of the present study showed well - controlled diabetes in the majority of patients attending diabetic clinic .
also , the duration of dm was less than 10 years in the majority of patients .
no statistically significant difference ( p>0.05 ) between the patients with or without dm - specific cutaneous disorders was noticed in the present study with particular reference to age and gender distribution , duration of dm , and fpg .
this is mainly because the majority of specific skin disorders in the present study were acanthosis nigricans , acrochordon , and uncomplicated infections which are not related to chronic hyperglycemia ( discussed in detail below ) .
there was no statistically significant difference between the occurrence of peripheral neuritis and various dm - specific cutaneous disorders .
low prevalence of systemic complications in the present study may be due to shorter duration of dm .
acanthosis nigricans and acrochordon , manifestations of insulin resistance which may be present before the expression of dm , were the predominant dermatoses with known pathogenesis . increased levels of insulin act on insulin like growth factor ( igf ) receptors , resulting in development of acanthosis nigricans .
acrochordon has been regarded as a sign of impaired glucose tolerance , dm , and increased cardiovascular ( atherogenic lipid profile ) risk .
the association between dm and increased susceptibility to infection in general is not supported by strong evidence .
however , streptococcal , pseudomonas , and candidal infections are known to occur with increased frequency in dm .
there are no conclusive evidences that diabetic patients are susceptible to dermatophytoses or staphylococcal skin infections . however , the patients especially with poorly controlled diabetes are at increased risk of severe and recurrent infections , and complications . as in nondiabetics ,
rate of exposure to the organisms seems to determine the occurrence of infections in diabetic patients .
the predominance of infection in males in the present study may be due to increased likelihood of exposure to the infectious organisms and humid climatic and working conditions .
the absence of diabetic thick skin and severe infections , and the lower incidence of specific dermatoses with or without known pathogenesis in the present study when compared to other studies[1012 ] [ table 4 ] is mainly due to difference in the diabetic population ( type 1 vs. type 2 ) , well - controlled diabetes , and shorter duration of dm in the majority of patients , and also the source from where patients were drawn , i.e. , diabetic clinic . in spite of about half of the patients having peripheral neuritis , only one patient had diabetic foot .
comparison of specific cutaneous disorders with or without known pathogenesis , with other studies certain dermatoses with underlying autoimmune pathogenesis like vitiligo are known to occur in dm as a part of polyglandular autoimmune syndrome .
however , such an association was not noticed in several other studies , including the present one .
an association between psoriasis and increased cardiovascular risk and metabolic syndrome has been reported . while treating psoriasis patients , screening for metabolic syndrome and cardiovascular risk factors
insulin reactions may be local ( erythema or urticarial pruritic nodules ) or systemic ( generalized urticaria , rarely anaphylaxis ) .
the reactions are due to impurities in insulin preparations such as bovine or porcine proteins , additional peptides , preservatives , and additives . in the present study ,
similarly , lipodystrophy can be prevented by highly purified and recombinant insulin and injection site rotation .
lower prevalence of insulin reactions in the present study may be due to the use of human insulin .
the occurrence of nonspecific cutaneous disorders also has pathogenetic , prognostic , and therapeutic importance in diabetic patients .
autonomic neuropathy or age of stratum corneum proteins has been attributed to the pathogenesis of ichthyosis , xerosis , and pruritus .
the loss of cutaneous barrier in nonspecific disorders predisposes already susceptible diabetic patients to chronic and recurrent infections .
while treating the dermatoses with underlying dm , three issues need to be kept in mind .
usually , a prolonged systemic therapy is required because of chronicity and severity of dermatoses .
patients with onychomycosis should be treated aggressively with oral antifungals to avoid devastating secondary bacterial infections .
the second point is the interactions between the drugs used to treat dermatoses and oral hypoglycemic agents .
therefore , blood glucose levels should be monitored carefully , and accordingly , the dosage schedules of antidiabetic treatment need to be adjusted . accelerated aging of skin has been reported in patients with both types of dm , especially type 1 . however , in the present study , such skin lesions ( seborrheic keratosis , senile comedones , senile purpura , solar elastosis , idiopathic guttate hypomelanosis ) are mainly due to chronologic and photo aging .
the main goals of diabetic care are good glycemic control , physical exercise , medical nutritional therapy , diabetes self - management education , foot care , and early detection of nephropathy , retinopathy , and metabolic alterations .
a good glycemic control definitely reduces the incidence and severity of cutaneous disorders with or without known pathogenesis , as observed in the present study .
however , several nonspecific cutaneous disorders that occur in diabetic patients can increase the likelihood of exposure to infectious organisms and contact allergens , resulting in chronic and recurrent infections and eczemas , respectively .
long - term effects of dm on the microcirculation and on dermal collagen eventually result in skin disorders in almost all the diabetic patients .
thus , dermatologists play an important role in reducing the dermatologic morbidity , improvement of quality of life , and management strategy of diabetic patients .
it is necessary to have a dermatologist in the diabetic clinic along with other specialists for early detection of potentially grave or predisposing conditions and to provide a comprehensive diabetic care to the patients .
 background : the metabolic complications and pathologic changes that occur in diabetes mellitus ( dm ) influence the occurrence of various dermatoses.aim:to study the impact of control of diabetes on the pattern of cutaneous disorders.materials and methods : a cross - sectional descriptive study of patients attending diabetic clinic in a tertiary care hospital . 
 a total of 500 consecutive patients were studied . 
 detailed history , clinical examination and relevant investigations were done to diagnose diabetic complications and cutaneous disorders . 
 dermatoses with or without known pathogenesis were correlated with age , gender , fasting plasma glucose ( fpg ) , duration of diabetes , and complications of dm . 
 statistical analysis was carried out using student  
 t  
 test and chi - square test with 5% confidence interval ( p value 0.05).results : majority of patients had well - controlled ( fpg<130 mg / ml , 60% ) type 2 dm ( 98.8% ) . 
 no statistically significant difference ( p>0.05 ) between the patients with or without dm specific cutaneous disorders was noticed with reference to age and gender distribution , duration of dm and fpg . 
 signs of insulin resistance , acrochordon ( 26.2% ) , and acanthosis nigricans ( 5% ) were common , followed by fungal ( 13.8% ) and bacterial ( 6.8% ) infections . 
 eruptive xanthoma ( 0.6% ) , diabetic foot ( 0.2% ) , diabetic bulla ( 0.4% ) , diabetic dermopathy ( 0.2% ) , generalized granuloma annulare ( 0.2% ) , and insulin reactions ( 6.2% ) and lipodystrophy ( 14% ) were also seen.conclusion:well-controlled diabetes decreases the prevalence of dm - specific cutaneous disorders associated with chronic hyperglycemia . 
 it is necessary to have a dermatologist in the diabetic clinic for early detection of potentially grave or predisposing conditions . 
Introduction
Materials and Methods
Results
Discussion