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Zmiany skórne związane z hiperglikemią

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Długotrwała hiperglikemia, czyli przekroczenie normy stężenia glukozy we krwi, może prowadzić do poważnych powikłań. Objawy chorobowe związane z nieprawidłowym poziomem cukru mogą występować m.in. w obrębie skóry.

Prawidłowe stężenie glukozy we krwi mieści się w przedziale 70-100 mg/dl na czczo oraz <140mg/dl) do 2 godzin po posiłku. O hiperglikemii można mówić w przypadku gdy stężenie glukozy na czczo wynosi 100-125 mg/dl, a do 2 godzin po posiłku 140-199 mg/dl.

Skutki zdrowotne hiperglikemii

Utrzymująca się hiperglikemia prowadzi do rozwoju neuropatii i mikroangiopatii, w następstwie czego mogą wystąpić wielonarządowe powikłania, takie jak m.in. choroba niedokrwienna serca, udar, zawał, nefropatia cukrzycowa (mogąca prowadzić do niewydolności tego narządu), retinopatia cukrzycowa oraz zespół stopy cukrzycowej.

Długotrwale podwyższony lub niewyrównany poziom cukru we krwi ma negatywny wpływ na reakcje odpornościowe organizmu. Z tego względu u diabetyków z hiperglikemią wzrasta ryzyko infekcji. Zaburzone zostają również mechanizmy regeneracyjne organizmu.

Hiperglikemia a zmiany skórne

Zaburzenia czucia i krążenia związane z długotrwałą hiperglikemią mogą przyczynić się do wystąpienia objawów skórnych takich jak suchość i pękanie, któremu często towarzyszy nasilony świąd, nadmierne łuszczenie i rogowacenie, stwardnienie skóry. Zmniejsza się elastyczność skóry, natomiast jej podatność na uszkodzenia wzrasta. Mogą występować dolegliwości bólowe, pieczenie i mrowienie, a także zaburzenia czucia (przeczulica, ograniczenie/zniesienie czucia).

Mikroangiopatia spowodowana długotrwałą hiperglikemią może ponadto prowadzić do zróżnicowanych procesów chorobowych w obrębie skóry. Wyróżnia się wśród nich: obumieranie tłuszczowate, ziarniniak obrączkowaty, dermopatię cukrzycową, chorobę pęcherzową, rogowacenie ciemne. Z uwagi na upośledzenie procesów immunologicznych hiperglikemia zwiększa również ryzyko skórnych zakażeń bakteryjnych i grzybiczych.

Obumieranie tłuszczowate

Obumieranie tłuszczowate powoduje powstawanie w obrębie kończyn dolnych żółtawych, czerwonych lub brązowych, wyraźnie odgraniczonych, naciekowych zmian zapalnych. W obrębie zmian dochodzi do zaniku skóry i rozwoju martwicy. Gojenie zmian następuje z pozostawieniem blizn i ubytków.

Ziarniniak obrączkowaty

Objawy mają postać spoistych, niewielkich grudek lub guzków, występujących w skupiskach i szerzących się obwodowo. Zmiany tworzą obrączkowate ogniska o wałowato uniesionych brzegach i płaskim lub lekko zagłębionym środku.

Dermopatia cukrzycowa

Dermopatia cukrzycowa objawia się poprzez okrągłe lub owalne plamy na skórze. Zmiany ulegają stopniowemu złuszczaniu i goją się z pozostawieniem żółtobrunatnych blizn.

Choroba pęcherzowa

Na skórze występują pęcherze z niewielkim odczynem zapalnym. Zmianom nie towarzyszą dolegliwości bólowe. Pęcherze ustępują samoistnie po kilku tygodniach i mają tendencję do nawracania.

Rogowacenie ciemne

Zmiany w przebiegu rogowacenia ciemnego występują najczęściej na skórze w obrębie dołów pachowych, w pachwinach, na karku oraz wokół pępka. Mają postać miejscowych hiperpigmentacji z towarzyszącym nadmiernym rogowaceniem.

Zakażenia bakteryjne i grzybicze

Zakażenia szczepami bakterii takimi jak Pseudomonas aeruginosa oraz Staphylococcus aureus mogą prowadzić u cukrzyców do rozwoju takich jednostek chorobowych jak m.in. róża, liszajec zakaźny, czyraczność, zapalenie mieszków włosowych. Zmiany na podłożu infekcji grzybiczych występują często między palcami dłoni i stóp oraz w obrębie paznokci. Mogą również występować wyprzenia drożdżakowe, zlokalizowane najczęściej w fałdach skórnych (między pośladkami, w pachwinach, pod biustem).

Źródło:

Zozulińska-Ziółkiewicz D., Wierusz-Wysocka B., Leczenie ostrych stanów hiperglikemicznych – aktualne spojrzenie na stary problem, Diabetologia Kliniczna, 3/2013.

Lansang C., Umpierrez G.E., Leczenie hiperglikemii u hospitalizowanych chorych niebędących w stanie krytycznym, Diabetologia po Dyplomie, 6(1)/2009.

Kitabchi A.E., Umpierrez G.E., Murphy M.B. i in., Postępowanie w przełomach hiperglikemicznych u chorych na cukrzycę. Stanowisko American Diabetes Association, Diabetes Care, 2001; 24: 131-153.

Przeczytaj także: Bakteria jak w sieci pająka: naukowcy odkryli nowe mechanizmy immunologiczne

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