Поражения кожи при сахарном диабете: клиническая картина, диагностика, дифференциальная диагностика, особенности лечения

Токмакова А.Ю., Семенова Д.А., Зайцева Е.Л. Поражения кожи при сахарном диабете: клиническая картина, диагностика, дифференциальная диагностика, особенности лечения. Consilium Medicum. 2020; 22 (7): 64–68.
DOI: 10.26442/20751753.2020.7.200315

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Tokmakova A.Yu., Semenova D.A., Zaitseva E.L. Skin lesions in diabetes mellitus: clinical manifestations, diagnosis, differential diagnosis, features of treatment. Consilium Medicum. 2020; 22 (7): 64–68. DOI: 10.26442/20751753.2020.7.200315

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Аннотация

Сахарный диабет (СД) – одно из наиболее распространенных хронических заболеваний, которое регистрируется примерно у 6% населения. Различные изменения кожи у лиц с СД как 1, так и 2-го типа встречаются достаточно часто и способны вызывать определенные трудности в диагностике и выборе терапевтической тактики. Такие пациенты могут нуждаться в помощи не только эндокринолога, но и врачей других специальностей – дерматолога, хирурга, аллерголога. В статье представлены данные о наиболее часто встречающихся дерматологических заболеваниях, ассоциированных с СД, обозначены основные звенья их патогенеза, методы диагностики и дифференциальной диагностики. Обсуждены возможности использования метода ультразвукового сканирования кожи в диагностике и дифференциальной диагностике одного из наиболее распространенных при диабете дерматозов – липоидного некробиоза. Отмечены особенности терапии дерматологических заболеваний у больных с нарушенным углеводным обменом.

Ключевые слова: сахарный диабет, дерматоз, патогенез, диагностика, ультразвуковое сканирование кожи.

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Diabetes mellitus (DM) is one of the most common chronic diseases, which occurs in about 6% of the population. Various skin changes in individuals with both type 1 and type 2 DM are quite common and can cause certain difficulties in diagnosis and choice of therapeutic tactics. Such patients may need the help of not only an endocrinologist, but also doctors of other specialties – a dermatologist, a surgeon, an allergist. The article presents data on the most common dermatological diseases associated with DM, identifies the main links of their pathogenesis, methods of diagnosis and differential diagnosis. It discusses the possibilities of using the ultrasound skin imaging for the diagnosis and differential diagnosis of one of the most common dermatoses in diabetes, necrobiosis lipoidica. It considers the features of therapy for dermatological diseases in patients with impaired carbohydrate metabolism.

Key words: diabetes mellitus, dermatosis, pathogenesis, diagnostics, ultrasound scan of the skin.

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1. Атлас IDF, 2018. https://www.idf.org/50-idf-activities/533-idf-2018-statistics.html
2. Algorithms for specialized medical care for patients with diabetes mellitus. Pod is red. I.I.Dedova, M.V.Shestakovoi, A.Yu.Mayorova. Pod red. I.I.Dedova, M.V.Shestakovoi, A.Iu.Maiorova. 9-i vyp. Moscow, 2019 (in Russian).
3. Mahajan S, Karanne RV, Sharma SK. Cutaneous manifestation of diabetes mellitus. Indian J Dermatol Venereol Leprol 2003; 69:105–8.
4. Sasmaz S, Buyukbese MA, Cetinkaya A et al. The prevalence of skin disorders in type-2 diabetic patients. Int J Dermatol 2005; 3: 1.
5. Bhat YJ, Gupta V, Kudyar RP. Cutaneous manifestations of diabetes mellitus. Int J Diab Dev Ctries 2006; 26: 152–5.
6. Goyal A, Raina S, Kaushal SS et al. Pattern of cutaneous manifestations in diabetes mellitus. Indian J Dermatol 2010; 55 (1): 39–41.
7. Mertsalova I.B. Bolezni kozhi pri sakharnom diabete. Lechashchii vrach. 2007; 10: 56–9 (in Russian).
8. Morgan AJ, Schwartz RA. Diabetic dermopathy: A subtle sign with grave implications. J Am Acad Dermatol 2008; 58 (3): 447–51.
9. Lopez PR, Leicht S, Sigmon JR, Stigall L. Bullosis diabeticorum associated with a prediabetic state. South Med J 2009; 102 (6): 643–4. DOI: 10.1097/SMJ.0b013e3181a506d6. PubMed PMID: 19434030
10. Pickens S, Farber G, Mosadegh M. Eruptive xanthoma: a case report. Cutis 2012; 89 (3): 141–4. PubMed PMID: 22530333.
11. Digby M, Belli R, McGraw T, Lee A. Eruptive xanthomas as a cutaneous manifestation of hypertriglyceridemia: a case report. J Clin Aesthet Dermatol 2011; 4 (1): 44–6.
12. Henning JS, Fazio MG. Yellowish papules on a middle-aged man. Eruptive xanthoma. Am Fam Physician 2011; 83 (1): 73–4. PubMed PMID: 21888131.
13. Kong AS, Williams RL, Rhyne R et al. Acanthosis nigricans: high prevalence and association with diabetes in a practicebased research network consortium – a Primary care Multi-Ethnic Network (PRIME Net) study. J Am Board Fam Med 2010; 23: 476–85.
14. Kluczynik CE, Mariz LS, Souza LC et al. Acanthosis nigricans and insulin resistance in overweight children and adolescents. An Bras Dermatol 2012; 87 (4): 531–7.
15. Lee JM, Okumura MJ, Davis MM et al. Prevalence and determinants of insulin resistance among U.S. adolescents: a population-based study. Diabetes Care 2006; 29: 2427–32.
16. Sergeev A.Yu., Sergeev Yu.V. Fungal infections. A guide for doctors. Moscow: BINOM-Press, 2003 (in Russian).
17. Lynch JM, Barrett TL. Collagenolytic (necrobiotic) granulomas: part II – the "red" granulomas. J Cutan Pathol 2004; 31 (6): 409–18.
18. Holland C, Givens V, Smoller BR. Expression of the human erythrocyte glucose transporter Glut-1 in areas of sclerotic collagen in necrobiosis lipoidica. J Cutan Pathol 2001; 28 (6): 287–90.
19. Fernandez-Flores A. Necrobiosis lipoidica and cutaneous anaesthesia: immunohistochemical study of neural fibres. Folia Neuropathol 2008; 46 (2): 154–7.
20. Eberle FC, Ghoreschi K, Hertl M. Fumaric Acid Esters in Severe Ulcerative Necrobiosis Lipoidica: A Case Report and Evaluation of Current Therapies. Acta Derm Venereol 2010; 90: 104–6.
21. Sizmaz S, Pelit A, Bolat F et al. Periorbital necrobiosis lipoidica diabeticorum: case report. Int Ophthalmol 2008; 28 (4): 307–9.
22. Nakajima T, Tanemura A, Inui S, Katayama I. Venous insufficiency in patients with necrobiosis lipoidica. J Dermatol 2009; 36 (3): 166–9.
23. Roche-Gamón E, Vilata-Corell JJ, Velasco-Pastor M. Familial Necrobiosis lipoidica not associated with diabetes. Dermatol Online J 2007; 13 (3): 26.
24. Vasiliana MS, Kouris A, Stavrianeas N. Correlation of diabetes mellitus with necrobiosis lipoidica and granuloma annulare. Dermattikon, Greece 2010; 5–7 (73–78).
25. Bub JL, Olerud JE. Diabetes mellitus. In: Freedberg IM, Eisen AZ, Wolff K, Austen KF, Goldsmith LA, Katz SL, editors. Fitzpatrick’s dermatology in general medicine. New York, NY: McGraw-hill 2003; p. 1656–7.
26. Dermatovenereology, 2010. Pod red. A.A.Kubanovoi. Moscow: DEX-Press, 2010 (in Russian).
27. Skin diseases. Diagnostics and treatment. Tomas P. Khebif; pod obshch. red. A.A.Kubanovoi; per. s angl. 3-e izd. Moscow: MEDpress-inform, 2006; p. 578 (in Russian).
28. European guidelines for the treatment of dermatological diseases. Pod red. A.D.Katsambasa, T.M.Lotti. Moscow: MEDpress, 2009; p. 630 (in Russian).

Авторы

А.Ю. Токмакова*, Д.А. Семенова, Е.Л. Зайцева

ФГБУ «Национальный медицинский исследовательский центр эндокринологии», Москва, Россия
*alla-tokmakova@yandex.ru

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Alla Yu. Tokmakova*, Daria A. Semenova, Ekaterina L. Zaitseva

National Medical Research Center for Endocrinology, Moscow, Russia
*alla-tokmakova@yandex.ru

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