DIABETIC BULLA

By Gary M. White, MD


Diabetic bulla (DB) or bullosis diabeticorum is the spontaneous formation of noninflammatory blisters in a patient with diabetes mellitus where other primary blistering diseases have been excluded.

Clinical

A non-inflamed acral blister or blisters measuring from a few mm to several cm. most commonly on the feet is characteristic. Healing occurs without scarring. Two less common variants occur: tender non-scarring lesions in sun-exposed or tanned skin and a hemorrhagic type with scarring and separation below the DEJ.

Treatment

Healing usually occurs without scarring. Because the patient is diabetic and the location is often the distal legs or feet, healing may be slow. Good local wound care can help prevent superinfection. Blisters are usually popped and drained to prevent expansion, but the roof should be left on as it is a good covering. The area should be cleaned daily with soap and water and any denuded areas covered with vaseline and a bandage. Signs of infection should be discussed with the patient. Referral to a wound care clinic may be indicated in lesions slow to heal.

References

A 27-year-old African American male with past medical history significant for uncontrolled diabetes mellitus type I, diabetic vasculopathy, neuropathy, and medical noncompliance presented to our hospital with sudden onset of blisters on elbows bilaterally. Apparently, the patient slept on the floor and woke up 6 hours later with the skin lesions. (RegionalDerm Author's note: Is there a relation here to coma blisters?) Case Rep Endocrinol. 2014; 2014: 862912.

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