Non-ulcerative pathologies of the diabetic foot
Diabetes/Metabolism Research and Reviews, 24, (S1), . (doi:10.1002/dmrr.818).
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Many of the complications of the diabetes are well studied but robust
research documenting the cutaneous effects of the disease remains sparse.Various studies have suggested that the majority of patients with diabeteswill suffer a skin disorder during the course of their disease and for some, the skin changes may even precede the diagnosis of diabetes. Cutaneous pathology of the diabetic foot and lower leg can arise as a result of the direct or indirect effects of diabetic complications. The most common manifestations include fungal and bacterial skin infection, nail disease and diabetic dermopathy. Other less commonly observed conditions
include diabetic bullae, necrobiosis lipoidica diabeticorum (NLD), granulomaannulare and reddening of the soles. For many of the less common disorders,there is little in the way of effective treatment. However, much can be done in the clinical setting in the management of the more common manifestation such as bacterial and fungal infection. Fungal infection, in particular, although relatively inconspicuous, is a very common foot problem and if left untreated
can threaten tissue viability in the diabetic foot leading to secondary bacterial infection and cellulitis. Management of fungal disease is often considered difficult due to high relapse and re-infection rates, although by introducing a combination of therapies including mechanical and pharmacological the success in treating this stubborn condition can be greatly improved.
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