Diabetic bullae: 12 cases of a purportedly rare cutaneous disorder

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.

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.

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.

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.