Cleveland Clinic Journal of MedicineA Large, Painless Bulla on the Right Foot

Unveiling Bullosis Diabeticorum: A Window into Diabetic Microvascular Complications

A 71-year-old woman’s experience with a painless, large bulla on her foot provides a detailed insight into bullosis diabeticorum, a rare blistering condition predominantly seen in diabetic patients. This case underscores the importance of recognizing such dermatological manifestations in diabetic patients, offering vital insights into their potential underlying microvascular and metabolic disturbances. Physicians should consider this condition in their differential diagnosis to provide timely and appropriate care, while also appreciating its implications on broader diabetes management.

Key Points:

• A 71-year-old female with diabetic neuropathy presented with a large, painless bulla on her right foot, which expanded from a small vesicle over three days without preceding trauma or insect bites.
• The patient’s medical history includes type 2 diabetes mellitus, breast cancer, and hyperlipidemia, with a medication regimen of metformin, insulin lispro, anastrozole, and gabapentin.
• Physical examination revealed a 3.75 cm clear fluid-filled bulla at the base of the first metatarsal joint, with no signs of inflammation or other similar lesions.
• Despite the clear fluid in the bulla suggesting sterility, aspiration was avoided to prevent secondary infection, aligning with conservative treatment approaches for such lesions.
• Follow-up after four weeks showed complete resolution of the bulla without recurrence, alongside laboratory findings indicating poor glycemic control.
• Bullosis diabeticorum is a noninflammatory, blistering condition in patients with diabetes or prediabetes, characterized by spontaneous, tense blisters, particularly on lower extremities.
• The condition reflects potential underlying diabetic microangiopathy and metabolic disturbances, possibly contributing to premature connective tissue aging.
• Treatment is conservative, focusing on cleanliness and protection of the blister to prevent infection, with careful monitoring for signs of secondary infection.
• Differential diagnosis includes various bullous conditions, underscoring the need for careful clinical evaluation to distinguish bullosis diabeticorum from other dermatological entities.
• The case highlights the necessity of routine diabetes screening and monitoring for associated complications in patients presenting with such dermatological manifestations.

As referenced in the original article, bullosis diabeticorum is a rare disease, affecting approximately 0.5% of diabetic patients. Men are twice as likely as women to develop the condition.

More in Endocrinology, Diabetes & Metabolism