xseroza cutanata

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* Centrul de Diabetologie Cluj-Napoca.** Catedra de Dermatologie-Cosmetic, Facultatea de Farmacie, U.M.F. Cluj-Napoca.*** Clinica de Dermatologie, U.M.F. Cluj-Napoca.

XEROZA CUTANAT LA PACIENII CU DIABET ZAHARAT STUDIU CAZ-MARTOR

DIABETES MELLITUS PATIENTS WITH XEROTIC SKIN- A CASE AND CONTROL STUDY -

ANCA CRCIUN*, MIRELA MOLDOVAN**, FLORINA SLJAN**, C. VLAD**, AL. TTARU***

Cluj-Napoca

STUDII CLINICE I EXPERIMENTALECLINICAL AND EXPERIMENTAL STUDIES

Summary

Objectives: Diabetes mellitus is a systemic diseasewhich affects in time all the organs. Our primary objectivewas to measure water content of the skin of diabetic patientsand to compare it with healthy non-diabetic controls. Thesecondary objective was to determine if the insulino-treatedpatients have a more severe grade of cutaneous xerosis ascompared to diabetic patients treated with oral medication.

Material and Methods: This case-control study wasconducted on 44 diabetic patients and 41 controls. We

measured the stratum corneum (SC) hydration usingCorneometer CM 825, in 3 sites: the volar side of theforearm, the front-lateral side of the left hip and the dorsalside of the foot.

Results: The diabetic patients had a lower hydration ofthe forearm than controls. There was no difference betweencontrols and diabetic patients treated orally. The insulino-treated patients had a lower hydration than controls in hip,and in hip when compared to diabetic patients treated byoral therapy. When we compared patients with type 1diabetes and controls, the diabetics had a lower hydration inforearm and hip. Type 2 diabetic patients have a lowerhydration on the forearm than controls. There was nodifference between type 1 and 2 diabetic patients.

Conclusion: Diabetes affects the water content of the

skin. The insulino-treated patients are more affected thanthe diabetic patients treated with oral therapy. There is nodifference between type 1 and type 2 diabetic patientsregarding the water content of SC.

Keywords: diabetes mellitus, hydration, cuteneousxerosis corneum, corneometry.

Rezumat

Obiectiv: Diabetul zaharat este o boal sistemic, ceafecteaz n timp toate organele. Obiectivul nostru primara fost s aflm dac diabetul zaharat afecteaz gradul dehidratare cutanat, comparativ cu un lot de control.Obiectivul secundar a fost s aflm dac pacieniiinsulinotratai au un grad de xeroz cutanat mai avansatdect diabeticii tratai cu antidiabetice orale (ADO).

Material i metod: Au participat la acest studio 44de pacieni diabetici i 41 de subieci de control. A fostmsurat gradul de hidratare cutanat a stratului cornos

(SC) cu ajutorul Corneometer CM 825 n trei puncte:faa volar a antebraului stng, faa antero-lateral acoapsei stngi i faa dorsal a piciorului stng.

Rezultate: Pacienii diabetici au avut un grad dehidratare semnificativ mai redus la nivelul antebraului fa delotul de control. Nu a existat diferen semnificativ statisticntre lotul de control i diabetici tratai cu ADO. Diabeticiiinsulinotratai au avut tegumentul semnificativ maideshidratat fa de martori la nivelul antebraului i al coapsei.Comparnd subiecii sntoi cu diabeticii tip 1, am obinutsemnificaie statistic la nivelul antebraului i coapsei,diabeticii fiind maideshidratai. Diabeticii tip 2 au tegumentulmai deshidratat la nivelul antebraului fa de lotul de control.Nu a existat diferen semnificativ statistic ntre grupurile dediabetici la niciunul dintre punctele de msurare.

Concluzii: Diabetul afecteaz coninutul de ap al

tegumentului. Diabeticii insulinotratai sunt mai afectaidect diabeticii tratai cu terapie oral. Nu exist diferenentre diabetici tip 1 sau 2 n ceea ce privete coninutul deap al SC.

Cuvinte cheie: diabet zaharat, hidratate, xerozcutanat, strat cornos, corneometrie.

DermatoVenerol. (Buc.), 55: 79-87


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Introducere

Diabetul zaharat este responsabil pentrumultiple afectri ale tegumentului, unele studiiindic o legtura ntre diabet i diverse

manifestri cutanate variind ntre 11,4% i 71%[1]. Xeroza cutanat este cea mai frecventafectare non-infecioas a tegumentului lapacienii cu diabet zaharat [2]. Pacienii diabeticiprezint frecvent xeroz cutanat la nivelulplantelor, mai ales la nivelul calcielor. ntr-unstudiu ce a cuprins 352 de pacieni diabetici,82,1% dintre acetia aveau xeroz cutanat ifisuri la nivelul plantelor [3]. Netratat, xerozacutanat crete riscul complicaiilor, cum ar fiinfecia, ulceraiile i mai ales formarea de calus.

Xeroza cutanat este frecvent ntlnit n

populaia general. Este o problem pentru5985% dintre cei cu vrste peste 64 ani [4], fiinduna dintre cele mai frecvente afeciuni non-infecioase i la pacienii cu diabet zaharat. Dateledin literatur sugereaz c prezena xerozeicutanate crete riscul de infecii i ulcere depresiune [5-7]. Poate s apar n orice regiune acorpului, mai vulnerabil fiind faa, minile,plantele, gleznele i axilele. Dac filmul lipidic dela suprafaa tegumentului este ndeprtat, pieleadevine uscat, putnd s se fisureze i s seinfecteze. Ulcerele de presiune sunt arii limitatede distrucie tisular cauzate de compresiaesutului moale ntre o proeminen osoas i osuprafa extern dur, pe o perioad mai lungde timp. Stratul cornos deshidratat este pre-cursorul ulcerului de presiune, fiind dovedit caceste ulcere pot fi prevenite prin aplicarea dehidratante ale stratului cornos [8-9].

Xeroza cutanat, alturi de formarea calu-sului, joac un rol cheie n patologia picioruluidiabetic, una dintre complicaiile majore alediabetului zaharat, dup cum arat un articol

publicat n noiembrie 2006 [10].Cauzele comune ale xerozei cutanate sunt:scderea hidratrii, utilizarea apei fierbinipentru igiena personal, utilizarea spunului cupH acid, ncrctura genetic, naintarea nvrst, factori ambientali (poluare, frig, scdereaumiditii aerului). Xeroza cutanat poate s fieprodus i de condiiile patologice, cum ar fidermatita atopic, malnutriia, insuficiena renalsau diabetul zaharat.

Introduction

Diabetes is responsible for multiple impairedskins, studies concerning the connection betweendiabetes and various cutaneous manifestations

showing damage in proportions ranging between11.4% and 71% [1]. Xerotic skin is the mostcommon non-infectious skin damage in patientswith diabetes [2]. Diabetic patients often presentcutaneous xerosis of the soles, especially in theheels. In a study that included 352 diabeticpatients, 82.1% of them had skin xerosis andcracks in the soles [3]. Untreated, xerotic skinincreases the risk of complications such asinfection, ulceration and especially the formationof callus.

Xerotic skin is common in the general

population. It is a problem for 59-85% of thoseaged over 64 years [4], is one of the most commonnon-infectious diseases and frequent in diabetesmellitus patients. The literature suggests thatxerotic skin increases the risk of infections andpressure ulcers [5-7]. It may occur in any regionof the body; the more vulnerable are the face,hands, soles, ankles and axillae. If the lipid filmfrom the surface skin is removed, the skin

becomes dry, cracked and liable to infection.Pressure ulcers are limited areas of tissuedestruction caused by compression of soft tissue

between a prominent bone and an externalsurface over a long period of time. Dehydratedstratum corneum is the precursor of pressureulcers; there is evidence that these ulcers can beprevented by applying hydrating lotions on thestratum corneum [8-9].

Cutaneous xerosis, along with callusformation, plays a key role in diabetic footpathology, one of the major complications ofdiabetes, according to an article published inNovember 2006 [10].

Most common causes of skin xerosis are:

reduction of hydration, use of hot water forpersonal hygiene, using soap with acid pH,genetic load, age, ambient factors (pollution, coldweather, decreasing air humidity). Xerotic skincan appear under pathological conditions such asatopic dermatitis, malnutrition, renal failure ordiabetes.

Pruritus leads to tegument damage byscratching, followed by inflammations orcutaneous lesions. Secondly, ambient allergens


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Pruritul duce la lezarea tegumentului pringrataj, urmat de inflamaie sau leziuni cutanate.Secundar, alergeni ambientali i ageni patogenipot ptrunde n tegument, crescnd riscul de

apariie a dermatitei de contact i a infeciilor.Se cunoate semnificaia insulinei ca factor decretere vital n culturile de keratinocite iimportana acesteia n proliferarea, migrarea idiferenierea keratinocitelor n epiderm al pacien-ilor cu diabetul duce la alterarea funciilorstratului cornos [11].

Acestea fiind tiute, obietivul nostru primar afost s aflm dac diabetul zaharat afecteazgradul de hidratare cutanat, comparativ cu unlot de control. Obiectivul secundar a fost s aflmdac pacienii insulinotrani au un grad de xeroz

cutanat mai avansat dect diabeticii tratai cuantidiabetice orale (ADO) i dac exist diferenn ceea ce privete gradul de hidratare ntrediabeticii tip 1 i cei cu tip 2.

Pacieni i Metod

La studiu au participat 44 de pacienidiagnosticai de minim 6 luni cu diabet zaharatde tip 1 sau tip 2 n comformitate cu criteriileADA (2006) [12] [tabelul 1], acetia alctuind lotulde studiu. Lotul de control a fost alctuit din 41

de martori, ajustai pentru vrst i gen.Msurarea gradului de hidratare s-a fcut ntrei puncte: faa volar a antebraului stng, faaantero-lateral a coapsei stngi i faa dorsal apiciorului stng. nainte de msurare, parti-cipanii au fost climatizai timp de aproximativ15 minute la temperatura de 2024C i umiditatede 3045%. n ultimele trei ore participanii nu

and pathogens can penetrate the skin, increasingthe risk of contact dermatitis and infections.

The significance of insulin as growth factorvital in keratinocyte cultures is well known, as

well as its importance in the proliferation,migration and differentiation of epidermalkeratinocytes in patients with diabetes leads toimpaired stratum corneum [11].

Consequently, our primary objective was tofind out if diabetes affects the degree of skinhydration as compared to a control group. Thesecondary objective was to find out if insulin-treated patients have a higher degree exposure tocutaneous xerosis thant patients treated with oralanti-diabetics (ADO) and if there are differencesin the degree of hydration between diabetes type

1 and type 2.

Patients and Method

The study recruited 44 patients diagnosed atleast 6 months before with diabetes mellitus type1 or type 2, according to ADA criteria (2006) [12][Table 1], these forming the study group. Controlgroup was composed of 41 people of appropriateage and sex.

Measuring the degree of hydration was madeon three points: volar side of left forearm,

anterolateral side of left hip and dorsal side of leftfoot. Before measurement, participants were keptfor about 15 minutes at 20-240C and humidityof 30-45%. In the last three hours the participantswere not allowed to wash with soap and water on

body sites to be measured.Cutaneous hydration degree of stratum

corneum was determined by conometry using

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Simptome sugestive pentru diabet (poliurie, polidipsie,scderea inexplicabil n greutate) plus o valoare aglicemiei plasmatice la o determinare ocazional(indiferent de timpul scurs de la ultima mas) 200mg/dl (11.1 mmol/l);

sau glicemia a jeun 126mg/dl (7 mmol/l)*

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