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Bullosis Diabeticorum : Causes, Symptoms, Diagnosis, Treatment, Prevention

People with diabetes often tend to experience a sudden eruption of blisters on their skin. This is known as diabetic blisters or bullous diabeticorum. Sometimes also known as diabetic bullae, these blisters can indeed be a cause for worry when you first see them erupt. However, they are usually painless and tend to heal by themselves without leaving any scars behind.(12) Here’s everything you need to know about bullosis diabeticorum, its causes, symptoms, diagnosis, and available treatments.

What is Bullosis Diabeticorum?

Bullous diabeticorum is the medical term used to refer to diabetic blisters. How often these blisters develop varies from person to person and is common in people who do not have their blood sugar levels under control. These blisters are painless and usually heal on their own. Most cases of bullous diabeticorum do not need any treatment.

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Though there are several skin conditions that are commonly associated with diabetes, but bullous diabeticorum is a pretty rare condition. An article published in the International Journal of Diabetes in Developing Countries found that this disorder develops in only 0.5 percent of people in the US who have diabetes.(3) Diabetic blisters are almost twice as likely to develop in men than in women.(4)

Bullous diabeticorum usually develops on your feet, toes, and legs. Though less common, but they can also appear on your arms, hands, and fingers. They are usually small in size, but occasionally they can be as large as six inches even. They typically appear like conventional blisters that erupt when you get burned, but these are without the accompanying pain. Diabetic blisters rarely develop as just one lesion. Instead, they appear in clusters, or they are bilateral. Diabetic blisters tend to contain a colorless, sterile fluid, and they are commonly quite itchy. The skin surrounding these blisters also does not usually turn red and swollen. However, if the skin turns red and there is swelling, you should see your doctor at the earliest.(56)

What are the Causes of Bullosis Diabeticorum?

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The exact cause of bullous diabeticorum is unknown, and many times, the lesions may appear without any apparent injury. One common cause of blisters in people with diabetes is a fungal infection caused by Candida albicans. Another reason for getting blisters can be wearing shoes that don’t fit well.(7)

Of course, the biggest reason of why some people get bullous diabeticorum is because their blood glucose levels are not properly managed and not under control. People who have diabetic neuropathy, a condition that causes damage to the nerves that reduces sensitivity to pain, are more susceptible to getting diabetic blisters. In some cases, peripheral artery disease is also believed to have a role to play.

Symptoms of Bullosis Diabeticorum

As mentioned above, bullosis diabeticorum is most commonly observed in people who do not have their blood sugar levels under control for a prolonged period of time. Despite this, some people may even observe that getting these diabetic blisters are the first symptom of prediabetes or even diabetes.(8)

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These blisters appear like clear bumps, usually on the legs, feet, and toes, and they may even show up on the hands, fingers, and hands. These blisters may:

  • Be of an irregular shape
  • Be filled with a clear fluid
  • Cause an itching sensation
  • Appear in a cluster or as a single lesion, though this is less common
  • Be up to six inches across

The skin around these blisters usually appears to be healthy, but if the skin is swollen or red, you should consult a doctor at the earliest.

What is the Treatment for Diabetic Blisters?

People with diabetes have a high risk of infection and ulceration. This is why if you have diabetes and you suddenly notice blisters on the skin, you should have them checked out by a dermatologist to rule out anything more serious. Diabetic blisters usually do not require any specific treatment and tend to heal within two to five weeks on their own.(9)

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The fluid present inside the blisters is sterile, and to prevent any kind of infection, you should avoid puncturing or popping these blisters. However, if the lesion is large, you should see a doctor to help drain the fluid. This helps keep the skin intact and acts as a covering for your wound. This is usually not the case if the blister ruptures suddenly by mistake.

You can treat diabetic blisters with an antibiotic ointment or cream and also bandaged to keep the area protected from further injury. If you have severe itching, your doctor may prescribe a steroidal cream for relief.(10)

If the blisters are too large, painful, persistent, or there is swelling, you can treat them with the following:

  • Use Saline Compresses: These can help provide relief from irritation and itching.
  • Aspiration: In this process, a doctor will drain the blister, leaving the roof intact, which reduces the risk of infection.
  • Bandaging: This will keep the blister and surrounding skin protected from scratching or bursting.
  • Topical Antibiotics Or Steroids: These are usually used in severe cases of diabetic blisters but are typically used as a last option for treatment. These are also unnecessary for most cases of diabetic blisters.

Overall, though, the only way you can prevent diabetic blisters or speed up their healing if you have them is by keeping your blood glucose levels under control. Managing your diabetes is essential if you want to avoid many skin conditions.

Is it Possible to Prevent Bullosis Diabeticorum?

It is necessary that you remain vigilant about the condition and hygiene of your skin if you have diabetes. Lesions and blisters may go unnoticed if you have nerve damage, which is quite common if you have diabetes. There are several things you can do to prevent the development of diabetic blisters and also to avoid secondary infections from lesions. Here are some things you can do to prevent bullous diabeticorum:(1112)

  • Inspect your feet thoroughly every night before going to bed.
  • Make sure to wear comfortable shoes. They should not be too tight.
  • Keep your feet safe from injury by wearing covered shoes and socks.
  • When wearing new shoes, break them in slowly.
  • Wear gloves when using gardening equipment, handheld tools, and even scissors. These can cause scissors.

In some people, exposure to ultraviolet light can cause blisters. To avoid this, limit your exposure to the sun and apply sunscreen when stepping out.

Conclusion

Bullous diabeticorum is a rare occurrence, but it can be common in people who do not have their blood sugar levels under control as compared to those who have their diabetes under control. Diabetic blisters are usually painless and, most of the time, tend to heal on their own within a few weeks. Nevertheless, since having blisters increase the risk of developing secondary infections, it is a good idea to have them checked out by a doctor, especially if there are some other accompanying symptoms as well.

References:

  1. Basarab, T., Munn, S.E., McGrath, J. and Jones, R.R., 1995. Bullosis diabeticorum. A case report and literature review. Clinical and experimental dermatology, 20(3), pp.218-220.
  2. Toonstra, J., 1985. Bullosis diabeticorum: report of a case with a review of the literature. Journal of the American Academy of Dermatology, 13(5), pp.799-805.
  3. Ghosh, S., Bandyopadhyay, D. and Chatterjee, G., 2009. Bullosis diabeticorum: A distinctive blistering eruption in diabetes mellitus. International Journal of Diabetes in Developing Countries, 29(1), p.41.
  4. Derighetti, M., Hohl, D., Krayenbühl, B.H. and Panizzon, R.G., 2000. Bullosis diabeticorum in a newly discovered type 2 diabetes mellitus. Dermatology, 200(4), pp.366-367.
  5. Cantwell, A.R. and Martz, W., 1967. Idiopathic bullae in diabetics: bullosis diabeticorum. Archives of Dermatology, 96(1), pp.42-44.
  6. Kurdi, A.T., 2013. Bullosis diabeticorum. The Lancet, 382(9907), p.e31.
  7. Larsen, K., Jensen, T., Karlsmark, T. and Holstein, P.E., 2008. Incidence of bullosis diabeticorum–a controversial cause of chronic foot ulceration. International wound journal, 5(4), pp.591-596.
  8. Lopez, P.R., Leicht, S., Sigmon, J.R. and Stigall, L., 2009. Bullosis diabeticorum associated with a prediabetic state. Southern medical journal, 102(6), pp.643-644.
  9. Zhang, A.J., Garret, M. and Miller, S., 2013. Bullosis diabeticorum: case report and review. Nz Med J, 126(1371), pp.91-4.
  10. Ghosh, S., Bandyopadhyay, D. and Chatterjee, G., 2009. Bullosis diabeticorum: A distinctive blistering eruption in diabetes mellitus. International Journal of Diabetes in Developing Countries, 29(1), p.41.
  11. Gupta, V., Gulati, N., Bahl, J., Bajwa, J. and Dhawan, N., 2014. Bullosis diabeticorum: rare presentation in a common disease. Case Reports in Endocrinology, 2014.
  12. Anand, K.P. and Kashyap, A.S., 2004. Bullosis diabeticorum. Postgraduate Medical Journal, 80(944), pp.354-354.
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