Diyabetes Mellitusun Kutanöz Bulguları
Özet
Diyabetes mellitus (DM), dünya çapında ciddi morbidite ve mortaliteye yol açan yaygın bir halk sağlığı sorunudur. Diyabetik hastaların %30-79'unda hastalığa bağlı kutanöz bulgular gelişmektedir. Bu bulgular benign tablolardan hayatı tehdit eden durumlara kadar geniş bir yelpazede görülebilir. Hiperglisemi patogenezde başrolü oynamakta; keratinosit ve fibroblast fonksiyonlarını bozarak, proteinlerin enzimatik olmayan glikasyonunu artırmakta ve cilt yapısını değiştirmektedir. Kutanöz bulgular patogenezlerine göre metabolik, enfeksiyöz, vasküler ve nöropatik olarak sınıflandırılır. Sık görülen klasik bulgular arasında akantozis nigrikans, akrokordon, diyabetik dermopati, diyabetik bül, nekrobiyozis lipoidika ve kazanılmış perforan dermatoz yer alır. Ayrıca amputasyon riski taşıyan diyabetik ayak sendromu ile tırnak değişiklikleri önemli komplikasyonlardandır. Diyabet tedavisinde kullanılan insülin enjeksiyonları lipohipertrofiye, sürekli glikoz monitörleri kontakt dermatite ve çeşitli oral antidiyabetikler ise ekzantematöz veya likenoid ilaç erüpsiyonlarına yol açabilir. Hekimlerin bu kutanöz belirtileri erken tanıması, iyi bir glisemik kontrolün sağlanması ve multidisipliner yönetim, hastaların yaşam kalitesini artırmada ve mortaliteyi azaltmada kritik öneme sahiptir.
Diabetes mellitus (DM) is a widespread global public health issue causing significant morbidity and mortality. Cutaneous manifestations are reported in 30-79% of diabetic patients, ranging from benign lesions to life-threatening conditions. Hyperglycemia plays a major role in the pathogenesis by impairing keratinocyte and fibroblast functions, increasing non-enzymatic glycation of proteins, and altering skin structure. Cutaneous signs are classified as metabolic, infectious, vascular, and neuropathic based on their pathogenesis. Common classic manifestations include acanthosis nigricans, skin tags, diabetic dermopathy, bullosis diabeticorum, necrobiosis lipoidica, and acquired perforating dermatosis. Furthermore, diabetic foot syndrome, which carries an amputation risk, and nail changes are critical complications. Regarding DM treatments, insulin injections may cause lipohypertrophy, continuous glucose monitors can induce contact dermatitis, and various oral antidiabetics may trigger exanthematous or lichenoid drug eruptions. Early recognition of these cutaneous signs by clinicians, achieving optimal glycemic control, and multidisciplinary management are vitally important to improve patients' quality of life and reduce mortality rates.
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