Nontropical diabetic hand syndrome: A troubling new entity

The nontropical diabetic hand syndrome merits recognition as a serious hand infection and diabetic complication. Initially recognized in the tropics and called tropical diabetic hand syndrome, this entity has not been previously delineated in temperate regions. Due in part to its unremarkable initial presentation, nontropical diabetic hand syndrome is neglected in temperate zones of the world yet it can result in severe morbidity and mortality among diabetic patients. It is poorly understood, needs recognition, and mandates expedited treatment since its clinical presentation is often overlooked until serious consequences occur. Inner city diabetic patients with poor glycemic control appear to be particularly susceptible to developing nontropical diabetic hand syndrome. We review this new entity and differentiate it into three clinical presentations: (Stage I) superficial erosion and ulceration; (Stage II) cellulitis and necrosis; and (Stage III) gangrene. The treatment of this new diabetic syndrome involves aggressive glycemic control and possible surgical intervention. We stress the importance of recognizing the diabetic hand syndrome as a potentially disabling and life-threatening disorder in diabetics worldwide.