Bullosis diabeticorum

Background

• Rare, idiopathic bullous rash seen in diabetics
• Average age of onset is 55
• 2:1 Male:Female ratio

Clinical Features

• Discrete patch(es) of pruritic bullae, which usually erupt quickly.

Differential Diagnosis

Vesiculobullous rashes

Febrile

• Diffuse distribution
  • Varicella
  • Smallpox
  • Disseminated gonococcal disease
  • DIC
  • Purpural fulminans
• Localized distribution
  • Necrotizing fasciitis
  • Hand-foot-and-mouth disease

Afebrile

• Diffuse distribution
  • Bullous pemphigoid
  • Drug-Induced bullous disorders
  • Pemphigus vulgaris
  • Phytophotodermatitis
  • Erythema multiforme major
  • Bullous impetigo
• Localized distribution
  • Contact dermatitis
  • Herpes zoster
  • Dyshidrotic eczema
  • Burn
  • Dermatitis herpetiformis
  • Erythema multiforme minor
  • Poison Oak, Ivy, Sumac dermatitis
  • Bullosis diabeticorum
  • Bullous impetigo
  • Folliculitis

Evaluation

• Rule out life-threatening etiology
• Evaluate for nephropathy

Rash Red Flags

• Fever
• Toxic appearance
• Hypotension
• Mucosal lesions
• Severe pain
• Very old or young age
• Immunosuppressed
• New medication

Management

• Supportive
• May give topical antibiotic cream to prevent secondary infection

Disposition

• Discharge

See Also

• Vesiculobullous rashes