The association among skin findings, body mass index and vitamin D levels in patients with diabetes mellitus

Diabetes mellitus is the most common endocrine disease. The skin is affected by both acute metabolic disorders and degenerative complications of diabetes. The skin findings may be the first sign of diabetes or may be observed many years after the diagnosis of diabetes. There may also be other factors that affect skin findings in diabetic patients. We aimed to determine the skin findings of diabetic patients in our region and to determine the association of these findings with factors such as age, sex, type of diabetes, duration of diabetes, presence of vasculopathy, body mass index, vitamin D and HbA1c. Our study was performed with 602 patients, 20 with type 1 and 582 with type 2 diabetes mellitus, who were admitted to the endocrinology and/or internal medicine polyclinics. The findings obtained by a detailed dermatologic examination were compared with age, gender, type of diabetes, duration of diabetes, vasculopathy, body mass index, HbA1c and vitamin D levels. The most common findings among the patients with Type 2 diabetes were superficial fungal infections (84 %), acrochordon (59,1 %), senile angioma (52,1%), xerosis (49%) and seborrheic keratosis whereas the most common findings among the patients with Type 1 diabetes were superficial fungal infections (60 %), bacterial skin infections (45 %), acrochordon (25 %) and xerosis (25 %). Among all skin findings, a statistically significant relation was detected only between seborrheic keratosis and vitamin D level (p=0.004). A statistically significant relation was also detected among obesity and candidal infections (p=0.017), acrochordon (p=0.007), acanthosis nigricans (p<0.001), plantar hyperkeratosis (p=0.046) and psoriasis (p=0.001). Such correlations were also identified among HbA1c levels and candidal infections (p=0.043), diabetic dermopathy (p<0.001), diabetic foot (p=0.001), necrobiosis lipoidica (p=0.032) as well as vasculopathy and superficial fungal infections (p=0.005), diabetic dermopathy (p<0.001), palmar erythema (p=0.004). As a conclusion, many skin findings specific to the disease can be seen in diabetic patients and it should be known that the skin findings may be related to factors such as HbA1c, vasculopathy, obesity and vitamin D. Our study was the first study examining the connection between the skin findings and vitamin D in diabetic patients. In our study, the only significant relationship found with vitamin D was the one with seborrheic keratosis. There is a need for new studies to clarify the connection between vitamin D to skin findings. Keywords: Diabetes, Skin Findings, Diabetic Dermopathy, Obesity, Vitamin D