Madalina Marinescu

Chronic hyperglycemia profoundly impairs skin integrity, with dermatological complications affecting up to half of patients with diabetes mellitus. The objective of this study was to describe the spectrum, frequency, and clinical characteristics of skin lesions in patients with diabetes mellitus and to evaluate whether specific cutaneous signs are associated with an increased risk of subsequently developing type 2 diabetes. This retrospective observational study evaluated 960 cases admitted to the Dermatology Clinic of “Sf. Spiridon” Emergency County Clinical Hospital, Iași, between 2017 and 2022, complemented by an 11-year longitudinal follow-up (2011–2016). Ulcerative lesions predominated (85.7%), followed by inflammatory manifestations (12.4%), while classical diabetes-specific dermatoses represented 7%) was documented in 94.2% of patients, with the most severe lesions occurring in those with HbA1c > 10%. In the longitudinal analysis, patients who later developed diabetes initially presented significantly higher rates of xerosis, pruritus, and callus compared with the controls. Multivariate logistic regression identified xerosis (OR 4.70) and pruritus (OR 3.41) as independent predictors of future diabetes. These findings suggest that certain dermatological signs may serve as early non-invasive markers of metabolic dysfunction and highlight the importance of routine skin examination in diabetes risk stratification.

Background: Cutaneous manifestations are frequent in diabetes mellitus and may reflect systemic vascular injury. Among them, diabetic dermopathy, necrobiosis lipoidica, scleredema diabeticorum, bullosis diabeticorum, and eruptive xanthomas are clinically significant. Aim: To synthesize current evidence on the associative and potential predictive role of diabetic dermopathies as non-invasive indicators of cardiovascular and renal complications. Methods: A narrative review of studies published between 2010 and 2023 in PubMed, Scopus, and Web of Science was conducted, focusing on links between specific dermopathies and systemic outcomes. Results: Diabetic dermopathy shows consistent associations with microvascular complications such as retinopathy and nephropathy. Necrobiosis lipoidica and scleredema correlate with macrovascular disease and metabolic syndrome, whereas eruptive xanthomas indicate severe dyslipidemia and heightened cardiovascular risk. Evidence is predominantly cross-sectional, with limited sample sizes and heterogeneous diagnostic criteria. Conclusions: Diabetic dermopathies represent emerging clinical indicators of systemic vascular and metabolic burden. Their potential prognostic value supports the integration of dermatological assessment into comprehensive diabetes care. However, due to methodological limitations, these findings should be interpreted as associative rather than causal, and prospective studies are warranted to confirm their predictive significance.

Background: Cutaneous manifestations are frequent in diabetes mellitus and may serve as visible indicators of systemic complications. Among them, diabetic dermopathy, necrobiosis lipoidica, scleredema diabeticorum, and bullosis diabeticorum are clinically relevant. Aim: To review current evidence on the prevalence, pathophysiology, and prognostic value of diabetic dermopathies as non-invasive markers of cardiovascular and renal complications. Methods: A narrative review was conducted using PubMed, Scopus, and Web of Science databases. Studies in English published between 2010 and 2023 were included, focusing on associations between cutaneous manifestations and systemic vascular outcomes. Results: Diabetic dermopathy correlates with microangiopathy, retinopathy, nephropathy, and neuropathy [8,16]. Necrobiosis lipoidica and scleredema diabeticorum are linked to macrovascular complications and metabolic syndrome [9,17,18]. Eruptive xanthomas indicate severe dyslipidemia and cardiovascular risk [12,19]. Conclusions: Diabetic dermopathies should be recognized as clinical biomarkers of systemic complications. Integration of dermatological assessment into diabetes care can improve early detection of high-risk patients.

Infectious and inflammatory dermatoses featuring skin lesions with loss of tissue expose skin layers to microbial invasions, disrupt the normal skin microbiome, and potentially lead to sepsis. However, literature data on the incidence of cutaneous-onset sepsis are scarce. This retrospective observational study assessed hospital admissions for primary skin lesions without bacterial infections and sepsis during 2020–2022 in the largest emergency hospital in NE Romania. Of 509 patients, 441 had infected lesions, 78 had sepsis caused by venous ulcers from microbial eczema cellulitis, superinfected bullous dermatoses, erysipelas, and erythroderma. Cultured samples revealed S. aureus, P. aeruginosa, and E. coli; and K. pneumoniae and S. β-hemolytic associated with sepsis, even if this was rarer. Clinical manifestations included ulcerations, erosions, fissures, excoriations, bullae, vesicles, pruritus, tumefaction, edema, fever, chills, pain, adenopathy, and mildly altered mental status. Underlying chronic heart failure, atrial fibrillation, anemia, and type-1 diabetes mellitus were comorbidities associated with infection and sepsis. Significant associations and risk factors, including their combined effects, are discussed to draw attention to the need for further research and adequate management to prevent sepsis in adult patients of any age presenting with infected skin lesions (especially cellulitis) and comorbidities (especially type 1 diabetes mellitus and anemia).

In dermatological practice, disturbances of the skin microbiome are found in various infectious and inflammatory dermatoses featuring one or more skin lesions with loss of tissue, directly exposing skin layers to microbial invasions. Literature data on the incidence of cutaneous-onset sepsis are, however, scarce. This retrospective observational study assessed hospital admissions for primary skin lesions with vs. without bacterial infections and sepsis during 2020-2022 in the largest emergency hospital in NE Romania. Of 509 patients 441 had infected lesions, 78 had sepsis caused by venous ulcers microbial eczema cellulitis, superinfected bullous dermatoses, erysipelas, erythroderma. Cultured samples revealed S. aureus, P. aeruginosa, E. coli, with K. pneumoniae, S. β-hemolytic associated with sepsis even if rarer. Clinical manifestations included ulcerations, erosions, fissures, excoriations, bullae, vesicles, pruritus, tumefaction, edema, fever, chills, pain, adenopathy, mildly altered mental status. Underlying chronic heart failure, atrial fibrillation, anemia, type-1 diabetes mellitus were comorbidities associated with infection and sepsis. Significant associations and risk factors, including their combined effects, are discussed to draw attention to the need for further research and adequate management to prevent sepsis in adult patients of any age presenting with infected skin lesions (especially cellulitis) and comorbidities (especially type 1 diabetes mellitus and anemia).