ABSTRACT
Bullosis diabeticorum (BD) is an uncommon cutaneous manifestation of diabetes that can affect the upper limbs. It is characterized by spontaneous and painless non-inflammatory bloody blisters, which can progress to necrosis, requiring differential diagnosis to rule out other dermatological diseases, such as porphyria cutanea tarda, pseudoporphyria, epidermolysis bullosa acquisita, and pemphigoid, and vascular diseases, such as vasculitis, peripheral arterial disease, and Buerger's disease, among others. In this report, we describe a 77-year-old male patient with poorly controlled diabetes and hypertension who presented with spontaneous onset of lesions on the upper limbs, initially with bullous characteristics, progressing to necrotic ulcers after spontaneous rupture. A biopsy revealed hyaline thickening of the dermal vessels and subcorneal bullae, consistent with a diagnosis of BD. After smoking cessation and optimization of glycemia control combined with topical corticosteroid therapy, the condition improved and lesions began to heal. This presentation of BD involving the upper limbs is rare, requiring differential diagnosis to rule out other cutaneous and vascular lesions.
ABSTRACT
PURPOSE: To make a systematic review and meta-analysis of studies evaluating the effect of cabergoline (CBG) in the treatment of non-functioning pituitary adenomas (NFPAs). METHODS: The primary outcome was tumor shrinkage, using as cut-off a reduction of at least 20% of the NFPA size from baseline. The secondary outcomes were prevention of tumor progression, clinically required additional interventions and adverse events (AE). Search strategies were applied to MEDLINE, EMBASE, LILACS and CENTRAL. Independent reviewers assessed the study eligibility, extracted data, and evaluated risk of bias. Random meta-analysis for the proportion of tumor shrinkage, prevention of tumor progression, clinically required additional interventions and frequency of AE were conducted. RESULTS: Five studies were included. The meta-analysis of proportion was 19% for tumor shrinkage (95% CI 8-38%, 4 studies, 108 participants), 50% for prevention of tumor progression (95% CI 35-64%, 5 studies, 187 participants), 14% for clinically required additional interventions (95% CI 6-30%, 4 studies, 128 participants) and 2% for adverse events (95% CI 1-6%, 3 studies, 157 participants). CONCLUSIONS: Effect of CBG to promote tumor shrinkage in NFPAs was low, while prevention of tumor progression after surgery was seen in half of the cases, with a low frequency of adverse events. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020206778.
Subject(s)
Adenoma , Pituitary Neoplasms , Humans , Adenoma/pathology , Cabergoline/therapeutic use , Pituitary Neoplasms/drug therapyABSTRACT
Resumo A bullosis diabeticorum (BD) é uma manifestação cutânea infrequente do diabetes e pode afetar os membros superiores. Caracteriza-se pelo aparecimento espontâneo e indolor de flictenas não inflamatórias de aspecto sanguinolento, que podem evoluir para necrose, requerendo que se faça diagnóstico diferencial com doenças dermatológicas, como porfiria cutânea tarda, pseudoporfiria, epidermólise bolhosa adquirida e penfigoide bolhoso, e doenças vasculares, como vasculites, doença arterial periférica, doença de Buerger, entre outras. Neste relato, descreve-se o caso de um paciente masculino de 77 anos, hipertenso e diabético mal controlado, apresentando aparecimento espontâneo de lesões bolhosas de membros superiores, que evoluíram, após ruptura espontânea, para ulcerosas necróticas. A biópsia da lesão diagnosticou a presença de espessamento hialino de vasos dérmicos e de bolhas subcórneas, compatíveis com o diagnóstico de BD. Após a interrupção do tabagismo e a otimização do controle glicêmico associado a corticoterapia tópica, houve melhora, com cicatrização das lesões. A apresentação da BD em membros superiores é mais rara, sendo necessário o diagnóstico diferencial com outras lesões cutâneas e vasculares.
Abstract Bullosis diabeticorum (BD) is an uncommon cutaneous manifestation of diabetes that can affect the upper limbs. It is characterized by spontaneous and painless non-inflammatory bloody blisters, which can progress to necrosis, requiring differential diagnosis to rule out other dermatological diseases, such as porphyria cutanea tarda, pseudoporphyria, epidermolysis bullosa acquisita, and pemphigoid, and vascular diseases, such as vasculitis, peripheral arterial disease, and Buerger's disease, among others. In this report, we describe a 77-year-old male patient with poorly controlled diabetes and hypertension who presented with spontaneous onset of lesions on the upper limbs, initially with bullous characteristics, progressing to necrotic ulcers after spontaneous rupture. A biopsy revealed hyaline thickening of the dermal vessels and subcorneal bullae, consistent with a diagnosis of BD. After smoking cessation and optimization of glycemia control combined with topical corticosteroid therapy, the condition improved and lesions began to heal. This presentation of BD involving the upper limbs is rare, requiring differential diagnosis to rule out other cutaneous and vascular lesions.
