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[1]

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

External Links

References

Nguyen T and Freedman J. Dermatologic Emergencies: Diagnosing and Managing Life-Threatening Rashes. Emergency Medicine Practice. September 2002 volume 4 no 9.

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