The patient was given a diagnosis of bullosis diabeticorum , a benign self-limited condition. Bullous diabeticorum is trauma-induced, painless blistering that typically occurs in an acral distribution in individuals with diabetes.
The differential diagnosis for bullous diseases is vast and includes such dangerous diseases as pemphigus vulgaris and toxic epidermal necrolysis. The Nikolsky sign and the Asboe-Hansen sign are both positive in pemphigus vulgaris and toxic epidermal necrolysis, and negative in bullosis diabeticorum.
- The Nikolsky sign is positive if the skin shears off when lateral pressure is applied to unblistered skin.
- The Asboe-Hansen sign is positive if the bullae extend to surrounding skin when vertical pressure is applied.
In this case, the bulla was drained with a sterile needle and no further bullae developed.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Sauceda AT, Usatine R. Bullous diseases--overview. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine . New York, NY: McGraw-Hill; 2009:784-789.
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