糖尿病患者的皮肤病:综述

C. Diehl
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引用次数: 0

摘要

糖尿病(DM)是一种常见的代谢性疾病,其患病率估计在世界20-79岁年龄组人口中约为9.3%,相当于4.63亿受影响者。此外,这种流行率在今后几年可能还会增加。占糖尿病患者的90%以上。除全身并发症外,皮肤病学也可观察到这些并发症。根据该地区的情况,糖尿病患者中皮肤病的患病率从35.4%到98.8%不等。这使得这些症状成为皮肤科就诊的常见原因。最常见的疾病是皮肤感染,但黄指甲、念珠菌病、肢索、关节活动受限和特发性低黑素症也可能经常被观察到。糖尿病性皮肤病和糖尿病足综合征也很常见,如黑棘皮病和白癜风等色素沉着障碍。在不同类型的糖尿病(1型或2型)中,病变模式之间的差异尚不清楚。总体而言,在几项研究中,皮肤感染和干燥症显示出高度普遍和重要的皮肤病,与糖尿病类型无关。在皮肤感染中,真菌病因似乎是最常见的,而那些细菌来源是不太常见的。糖尿病通过几种机制影响皮肤-高水平的血糖通过损害体外角质形成细胞的正常功能,减少其增殖和分化,强烈影响皮肤稳态。它们也会导致晚期糖基化终产物(AGEs)的形成。后者是由蛋白质、脂质和核酸的糖基化形成的。它们在皮肤水平上具有多种有害作用:诱导活性氧(ROS)的形成,损害ROS的清除以及细胞内和细胞外蛋白的功能,并通过核因子κβ (NF-κβ)途径诱导促炎细胞因子。AGE改变胶原质的性质,降低其柔韧性和溶解度,增加其刚性,增厚真皮胶原,增加非酶糖基化的交联,参与纤维化的发展。糖尿病患者的皮肤血管变化与紫外线照射引起的血管变化相似。血管壁增厚,从大腿到足部增加,最明显的是毛细血管,导致血管反应性失败。本文旨在总结所有这些病理,报告其患病率,简要描述症状,发病机制和治疗指南。皮肤科医生在他们的治疗中起着关键作用,但在处理这些病理时,也能发现新的糖尿病病例。他们还必须促进这些患者的血糖控制。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Skin disorders in patients with diabetes mellitus: a review
Diabetes mellitus (DM) is a frequent metabolic disease whose prevalence is estimated to be around 9.3 % in the world population in the age group 20—79, corresponding to 463 million affected subjects. Moreover, this prevalence will probably increase in the course of the next years. It accounts for more than 90% of the diabetic patients. Besides systemic complications, those ay also be observed in dermatology. According to the region, the prevalence of skin disorders in patients suffering DM is ranging from 35.4 to 98.8 %. This makes these symptoms a frequent cause of consultation in dermatological practice. The most occurring disorders are skin infections, but yellow nails, candidiasis, acrochordons, limited joint mobility and idiopathic guttate hypomelanosis may also be frequently observed. Diabetic dermopathy and diabetic foot syndrome are also common, such as pigmentation disorders such as acanthosis nigricans and vitiligo. Differences between patterns of lesions remain unclear among types of DM (type 1 or type 2). Overall, cutaneous infection and xerosis showed to be highly prevalent and important skin disorders in several studies, regardless DM type. Among cutaneous infections, fungal aetiology appears to be the most common and those with bacterial origin are the less frequent.DM affects the skin through several mechanisms — High levels of glycaemia strongly affect skin homeostasis by impairing the normal functioning of keratinocytes in vitro, decreasing their proliferation and differentiation. They also lead to advanced glycation end products (AGEs) formation. The latter are formed from glycation of proteins, lipids and nucleic acids. They have various deleterious effects at skin levels: inducing reactive oxygen species (ROS) formation, impairing ROS clearance, as well as intra and extracellular proteins function, and inducing pro inflammatory cytokine through nuclear factor κβ (NF-κβ) pathway. AGE alters collagen properties, decreasing flexibility and solubility and increasing its rigidity, thickening dermal collagen, with increased cross linking from non-enzymatic glycosylation, participating in the development of fibrosis. In diabetic patients, the vascular changes found in the skin are similar to those caused by UV-exposure, i. e. thickening of the vessels walls, increasing from thigh to foot and most marked in the capillaries and leading to failure of vascular responsivenessThis paper is aimed to summarize all these pathologies, reporting their prevalence, giving a brief description of the symptoms, of their pathogenesis and guidelines for their management. Dermatologists have a key role in their treatment, but also in detecting new cases of DM when taking in charge these pathologies. They must also promote glycaemic control by these patients.
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