From the Research
Bullous diabeticorum is most commonly associated with type 1 and type 2 diabetes mellitus, particularly in patients with poorly controlled and long-standing disease, as evidenced by a case report and review published in 2018 1. The management and treatment of bullous diabeticorum in patients with diabetes mellitus (DM) primarily involve conservative measures to prevent infection and promote healing.
- The primary approach involves leaving the bullae intact when possible to serve as a natural barrier against infection.
- Gentle cleansing with mild antiseptic solutions and application of sterile, non-adherent dressings help protect these fragile lesions.
- If bullae rupture, the area should be kept clean and covered with appropriate wound dressings.
- Topical antibiotics may be used if signs of secondary infection appear, while systemic antibiotics are reserved for more severe infections.
- Optimizing glycemic control is essential as improved blood glucose management may reduce recurrence and promote healing, as suggested by a study published in 2018 2. Most diabetic bullae resolve spontaneously within 2-6 weeks without scarring, though they may recur.
- Patients should be educated to avoid puncturing intact bullae, to monitor for signs of infection (increased redness, warmth, pain, or purulent drainage), and to seek medical attention if infection is suspected.
- The exact pathophysiology remains unclear, but these lesions are believed to be related to microangiopathy, neuropathy, and other vascular changes associated with long-standing diabetes, explaining why they occur predominantly in patients with prolonged disease duration, as noted in a review published in 2017 3. It is also worth noting that bullosis diabeticorum can be a cutaneous marker for diabetes mellitus and the prediabetic state, and screening for diabetes may be beneficial in individuals presenting with this condition, as suggested by a systematic review published in 2017 3.