Abstract
Bullosis diabeticorum is a rare presentation of cutaneous manifestation most commonly affecting the lower limbs in patients with diabetes. The appearance, often as insidious as its resolution, is characterized by tense blisters on the skin surfaces of the lower limbs and the feet. The cause still remains unclear, but it may relate to microangiopathy and neuropathy. In this report, we present a case of a 64-year-old male with multiple episodes of blistering in the left lateral lower limb after a traumatic fall who was subsequently diagnosed with type 2 diabetes mellitus. The patient had a history of poorly controlled blood glucose and subsequently developed vasculopathy and peripheral neuropathy. Despite appropriate glycemic control and antibiotics therapy, the patient developed recurrent bullosis diabeticorum on five separate occasions during a 2-year span from 2005 to 2007. Building on our success with ischemic diabetic foot, we used bone marrow mesenchymal stem cell (BMMSC) transplantation therapy for bullosis diabeticorum. After a 9-month treatment, this patient developed another episode of cellulitis in the same lower limb which was successfully treated with antibacterial therapy. It is interesting that the patient reported no recurrence in the next 10-year follow-up span. This study demonstrates that bullosis diabeticorum could appear even before the onset of diabetes, and vascular insufficiency predisposes to the occurrence of bullosis diabeticorum. Our findings suggest that autologous BMMSC transplantation therapy may be an effective measure for recurrent bullosis diabeticorum; however, this will require further investigation to be conclusive. Early identification of diabetes and its complications and appropriate treatment may improve clinical outcomes and prevent lower limb amputation.Trial registration: ClinicalTrials.gov Identifier: NCT00955669. Registered on August 10, 2009.
Highlights
Dermatological diseases are relatively common in diabetic patients, in which they manifest cutaneously as a variety of conditions such as bacterial and fungal infections, diabetic dermopathy, granuloma annulare, and necrobiosis lipoidica diabeticorum [1]
Bullosis diabeticorum is a rare cutaneous disease, with 100 cases or case series reported in the literature [2], characterized by spontaneous noninflammatory manifestations, painless subcutaneous fluid-filled vesicles varying in size from a few millimeters to a few centimeters
We successfully treated diabetic critical limb ischemia with bone marrow mesenchymal stem cells (BMMSCs) [6, 7]. To further explore their benefits, we have administered BMMSC transplantation therapy to a patient with recurrent bullosis diabeticorum in the left lower limb complicated by limb ischemia and mild venous insufficiency
Summary
Dermatological diseases are relatively common in diabetic patients, in which they manifest cutaneously as a variety of conditions such as bacterial and fungal infections, diabetic dermopathy, granuloma annulare, and necrobiosis lipoidica diabeticorum [1]. Bullosis diabeticorum is a rare cutaneous disease, with 100 cases or case series reported in the literature [2], characterized by spontaneous noninflammatory manifestations, painless subcutaneous fluid-filled vesicles varying in size from a few millimeters to a few centimeters It is usually distributed in the lower extremities, in which there is an observed risk of developing secondary infection, including diabetic skin ulcer (Fig. 1a), osteomyelitis (Fig. 1b), or wet gangrene (Fig. 1c), even diabetic amputation. We successfully treated diabetic critical limb ischemia with bone marrow mesenchymal stem cells (BMMSCs) [6, 7] To further explore their benefits, we have administered BMMSC transplantation therapy to a patient with recurrent bullosis diabeticorum in the left lower limb complicated by limb ischemia and mild venous insufficiency
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