Severe palmoplantar keratoderma: a cutaneous complication from sub-optimally controlled type 2 diabetes

Area of Science:

• Endocrinology
• Dermatology
• Infectious Diseases

Background:

• Palmoplantar keratoderma (PPK) is characterized by excessive skin thickening on the palms and soles, which can be hereditary or acquired.
• Sub-optimally controlled diabetes mellitus is a risk factor for various complications, including rare dermatologic manifestations.
• This case involves a patient with type 2 diabetes presenting with diabetic ketoacidosis (DKA) and a severe necrotizing soft tissue infection.

Purpose of the Study:

• To report a case of palmoplantar keratoderma (PPK) in a patient with poorly controlled diabetes and a severe infection.
• To emphasize the importance of thorough dermatological assessment in diabetic patients.
• To highlight the need for a multidisciplinary approach in managing complex diabetes-related complications.

Main Methods:

• A 53-year-old female patient with a history of poorly controlled diabetes presented with DKA and a back infection.
• The patient exhibited marked plantar keratoderma and onychogryphosis, diagnosed as PPK.
• Treatment involved surgical debridement, antibiotics, DKA management, and topical urea cream for PPK.

Main Results:

• The patient was diagnosed with DKA and a methicillin-sensitive Staphylococcus aureus necrotizing soft tissue infection.
• Marked plantar keratoderma and onychogryphosis were observed, attributed to sub-optimally managed diabetes.
• Treatment with 40% urea cream resulted in gradual resolution of hyperkeratotic skin within weeks.

Conclusions:

• Sub-optimal diabetes control can lead to rare dermatologic complications like PPK.
• Prompt identification and management of infections are crucial in diabetic patients.
• A multidisciplinary approach involving dermatology, endocrinology, and allied health services is essential for comprehensive diabetes care and complication management.