Waxy skin

Abstract: Joint mobility was assessed in 80 consecutive adult noninsulin-dependent diabetic (NIDD) patients and 47 nondiabetic controls matched for age and sex. Impairment of mobility was observed in 36 NIDD patients but only 7 controls (p less than 0.01). There was no significant differences between diabetic patients with and without impaired mobility with regards to age, duration of diabetes, mean daily insulin dose, or overall diabetic control as assessed by the measurement of glycosylated haemoglobin (HbA1C). However, NIDD patients with impaired joint mobility had a significantly increased frequency of microvascular disease, as shown by retinopathy and/or nephropathy (42% versus 22%, p less than 0.05), were more often on insulin treatment (86% versus 63%, p less than 0.05) and more frequently had additional rheumatic disorders such as Dupuytren's contracture and osteoarthritis (36% versus 18%, p less than 0.05). In addition tight waxy skin over the phalanges was commonly associated with impaired mobility (58% versus 22%, p less than 0.01). Limitation of joint mobility was most prominent in the hands but caused no functional impairment. This finding may be an additional marker of microvascular disease in the adult diabetic patient.

Abstract: The skin is the largest of the body’s organs and therefore it is hardly surprising that it has manifestations due to diabetes mellitus. What does astonish physicians, particularly non-dermatologists, is the variety and number of these diabetic related cutaneous phenomena. Although there is uncertainty about the pathogenesis of many of these skin conditions, in no small part because of our imperfect understanding of the metabolic abnormalities of diabetes itself, many cutaneous signs are easily recognizable as diabetic markers, and threediabetic bullae, limited joint mobility and waxy skin, and diabetic dermopathy-are virtually diagnostic of diabetes. Some cutaneous conditions appear to be caused by the primary abnormalities of diabetes or by its major complications, vasculopathy, and neuropathy. Others are linked to altered immunologic causes, to changes in collagen, and some are a consequence of treatment. Several dermatoses, not generally thought to be linked to abnormal glucose metabolism, appear with greater than expected frequency in diabetics. The numerous skin problems of the diabetic patient have recently been addressed in a text specifically dealing with that subject.’ Dermatological disorders associated with diabetes generally appear after the primary disease has developed, but they may signal or appear coincidentally with its onset, or even precede diabetes by many years. It is the purpose of this review to outline the major dermatological manifestations of diabetes.

Abstract: Approximately 30% of patients with diabetes mellitus will have disease-related dermatological problems. Dry skin can be associated with autonomic neuropathy and may be fragile, promoting bacterial invasion. Any potentially infected’ diabetic foot’ must be taken seriously, and non-painful deep sepsis suspected if there is evidence of sensory loss. Consideration should be given to eliminating nasal carriage of staphylococci if recurrent superficial sepsis occurs in the presence of poor diabetic control. Fungal infections, both of skin and nails, are common but usually not serious in the absence of immunosuppression. Treatment with topical antifungals may need to be combined with systemic therapy for successful eradication. Systemic antifungal therapy should be carefully considered as treatment needs to be prolonged and is potentially toxic, particularly in individuals with diabetes mellitus who often have co-morbidities. Varicose eczema should be treated by physical therapies intended to improve venous return and prevent peripheral edema and tissue injury. Allergic dermatitis is commonly associated with topical treatments and other sensitizers. Many reactions are not apparent from history, and patch testing for sensitivity is recommended. There are several diabetes mellitus-specific conditions that dermatologists must be aware of, including, necrobiosis lipoidica diabeticorum, granuloma annulare, diabetic dermopathy (spotted leg syndrome or shin spots), diabetic bullae (bullosis diabeticorum), and limited joint mobility and waxy skin syndrome. Ulceration, due to varying combinations of peripheral vascular disease and sensory neuropathy, is the province of the specialist team dealing with the diabetic foot and should ideally be referred to an appropriate multidisciplinary team.

Abstract: Background : In some diabetic patients, the skin of the hands has a waxy appearance. Objective : To study subclinical skin stiffening in diabetic patients using a n