Cutaneous manifestations develop in
approximately 30% of persons with
diabetes. Premature atherosclerosis
is a common complication of the
disease and can cause peripheral infarction,
ulceration, and necrosis.
As seen here on the finger of a
64-year-old man who has a 25-year
history of diabetes mellitus, ulceration
secondary to insensible trauma
can arise from diabetic neuropathy.
Healing of such a lesion may be
further complicated by vascular insufficiency
related to the disease.
The pathogenic mechanism of vascular disease in diabetes is not clearly understood. Early
diagnosis and tight glucose control afford the best opportunity to delay disease progression.
This patient was referred to a vascular surgeon for evaluation and treatment.
(Case and photograph courtesy of Drs Charles E. Crutchfield III, Eric J. Lewis, and Humberto Gallego.)