MELLITUS
‘Nawaf Al-Mutairi
‘Skin infections are common in diabetic patients. ‘they can
feven be the presenting feature of diabetes mellitus. A high
index of suspicion in patients sufering from recurrent com:
mon skin infections, or with severe ancommon or rare inlee:
tions, sometimes helps in detecting diabetes in a. person
[previously not known to have this commen condition. There
‘can be many factors underlying increased susceptibility to skin
infections in diabetics including poor mierocitculation, hypo:
hhideoss, peripheral wascular disease, peripheral neuropathy.
and the decreased immune response seen in diabetics. Some
‘of these factors may result in poor wound healing for these
ppaticnts,
Decreased neutrophil chemotax
isposes diabetic patients to an increased susceptibility of
{infections The incidence of colonization as well as infections
‘of the skin with bacteria suchas Staphylococcus, Streptococcus,
and yeast (Candida albicans) in patients with poor control of
diabetes is increased. Dermatophyte infections are not more
frequent in diabetic than in nondiabetic individuals. Some
ening infections of skin
such as ne wt otitis externa, and
mucormycosis are more common én diabetics and require
special mention
fand phagocytosis pre
HISTORY
Before the advent of insulin and antibiotics, bacteria causing
severe or extensive furuncles,carbuncles,ecthyma, cellulitis, and
styes were frequent among diabetic patients. ‘These infections
are still commonly encountered among diabetic patients espe
silly in developing countries where the lifkong management
‘of underlying diabetes in many patients may not be optimum
because ofthe cast involved or gparance
EPIDEMIOLOGY
Poor glycemic control is oflen asociated wih an increased
incidence of skin infections in diabetics. Atleast one-third of
persons with diabetes have some cutaneous involvement dur
ing the course of this chron disease. Cutaneous infections are
among the more common skin manifestaitons of diabetes. The
‘incidence of skin infections in diabetics shows a close correla
‘tion to the patients’ mean blood glucose levels. Skin infections
‘occur i. 20% 10 50% of diabetics. but more often in type 2 dia
betic pati
16
DIAGNosIS
[Any person presenting with frequent, unusually severe of exten
sive common bacteria skin infections such as furuncles, carbun
«les cults, ethyma erythrasma, or rare but life-threatening
infections such as necrotizing fasciitis, malignant ots externa,
and mucormycosis should be investigated to rule out diabetes
Skin signs and symptoms may sometimes be surprisingly mis-
leading even in the presence of serious infections in diabetics
Bacteriologic culture and sensitivity evaluation of the properly
collected material in common infections, and Blood in severe
infections, is of paramount importance in management of
these infections. A simple investigation such ax Gram stain of
the purulent material may provide an early cue tothe etiology.
‘Gram stain is better than KOH examination in demonstrating
sorynbacteria causing erythrasma, Material for culkure may be
collected via swabbing, injecting saline into theafected area and
then aspirating the material, aspiration of blister fluid, or biopsy
However, even wit al these procedures bacterial culture may
not yield positive results in eonditions such ax eryipelas and
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