Endocrine diseases

Abstract

Diabetes mellitus is the most common endocrine disease characterized by various dermatological diseases and cutaneous manifestations in up to 70% of patients.1 Diabetic patients are prone to skin diseases accompanied by pruritus such as mycosis (tinea, candidosis) and bacterial infections, e.g., folliculitis. Generalized pruritus as a presenting symptom of diabetes may occur, but is not significantly more frequent than in nondiabetic patients. It was found to affect 2.7% of the diabetic population.2 Localized pruritus, especially in the genital and perianal areas, is significantly more common in diabetic women and mostly associated with poor diabetes control. 2 Pruritus vulvae was found to be significantly more common in diabetic women (18.4%) than in controls (5.6%).2 In some cases this may be due to predisposition to candidiasis or dermatophyte infections. A study from Kuwait described pruritus as the second most common manifestation seen in 49% of diabetic patients.3 There was no description included in distinguishing between local and generalized pruritus. Pruritus confined to the scalp was reported to be caused by diabetes, and all patients experienced complete relief when control of the underlying diabetes was achieved. 4 The mechanism of pruritus induction in diabetes is not known. Diabetic neuropathy presenting as distal symmetrical polyneuropathy is more characteristically associated with pain, burning or prickling sensation, and sensorimotor deficits, although pruritic sensations have been described as well. An investigation of the expression of cannabinoid CB1 receptors in models of diabetic neuropathy suggests that high glucose concentrations are associated with decreased expression of CB1 receptors in nerve cells.5 This decline may account for the neurodegenerative process observed in diabetes. © 2010 Springer-Verlag London.