1/3. Diabetic bullae: 12 cases of a purportedly rare cutaneous disorder.BACKGROUND: Spontaneous bullae are a characteristic type of skin lesion occurring in patients with diabetes mellitus. These diabetic bullae are considered to be a rare phenomenon; only about 100 cases have been described in the literature since the disorder was first reported 70 years ago. methods: We collected a series of patients with diabetic bullae who were referred to us at a veterans Affairs Medical Center Clinic specializing in diabetic foot problems. We then reviewed the medical literature for similar cases and summarized the available information. RESULTS: We saw 12 patients with typical diabetic bullae over an 8-year period in our clinic. The clinical presentation and outcome of the lesions in these patients were similar to those in previously reported cases. The patients were mostly elderly, all but one had lesions located on the lower extremities, all had peripheral neuropathy, two had secondary staphylococcal infection of their bullae, and in all patients the lesions healed without scarring. Although most of the patients had had previous similar lesions, the diagnosis of diabetic bullae had not been previously reported in any of them. CONCLUSIONS: We have reviewed the clinical syndrome of diabetic bullae and presented brief clinical details of these cases; we offer several vignettes and photographs of these lesions to remind clinicians of what we believe is a not so rare cutaneous disorder.- - - - - - - - - - ranking = 1keywords = neuropathy (Clic here for more details about this article) |
2/3. coma blisters, peripheral neuropathy, and amitriptyline overdose: a brief report.BACKGROUND: coma blisters are most commonly associated with barbiturate and benzodiazepine overdose; however, they have also been described in association with many other substances, including amitriptyline. OBJECTIVE: To review the literature on the clinical manifestations of coma blisters in the setting of amitriptyline overdose. methods: Case report and literature review. RESULTS: coma blisters in association with amitriptyline overdose have rarely been documented in the literature. Of the few reported cases, peripheral neuropathy has been present two (including our case report) out of four times. CONCLUSION: amitriptyline is known to impair endothelial cell tight junction integrity. Thus, individuals with amitriptyline overdose may be predisposed to microvascular damage during the compression imposed from a comatose state. This may help to explain the tendency for patients to present with the interesting triad of coma, blisters, and neuropathy.- - - - - - - - - - ranking = 6keywords = neuropathy (Clic here for more details about this article) |
3/3. Blisters, ulceration and autonomic neuropathy in carpal tunnel syndrome.We describe three patients with trophic ulceration and blistering of the fingertips associated with carpal tunnel syndrome. One of the patients also had non-insulin-dependent diabetes mellitus. Autonomic neuropathy distal to the carpal tunnel was probably present in all subjects at the time of presentation; in the patient with recent symptoms the skin was warm, and sweating was virtually absent, whilst the other two patients described cold skin, consistent with prolonged autonomic neuropathy.- - - - - - - - - - ranking = 6keywords = neuropathy (Clic here for more details about this article) |