Manifestaciones cutáneas en pacientes con diabetes mellitus en un centro de atención primaria en Ecuador

BACKGROUND: Diabetes mellitus is a major public health problem and many skin conditions have been associated with it. OBJECTIVE: To determine the prevalence of skin conditions in patients with diabetes, and its correlation with adequate metabolic control or lack thereof, which have never been studied in Ecuadorian patients. MATERIAL AND METHOD: An analytical cross-sectional study was done from October 2015 to March 2016 with a population of patients with type-2 diabetes from a primary health care centre in Quito, Ecuador. Patients were randomly assigned to one of three certified dermatologists for a complete evaluation. Clinical and demographic variables were obtained from the medical files and the level of glycosylated haemoglobin (HbA1c) was measured in all patients to categorise them as well controlled (HbA1c ≤ 7%) or poorly controlled (HbA1c > 7%). The prevalence of skin conditions between groups was compared using Yates' χ² test. RESULTS: There were included 267 patients with type-2 diabetes; 97% of patients presented at least one skin condition, and 32 different conditions were identified. The most prevalent cutaneous abnormalities were onychomycosis (45%), acrochordons (42%) and xerosis (39%); 41% of the population was considered to have adequate metabolic control as per the value of HbA1c. Onychomycosis was the only skin disease that had a significantly higher prevalence in poorly controlled patients (p = 0.04). CONCLUSIONS: Skin problems, especially fungal infections, are present in a great majority of patients with diabetes. Such problems are easy to evaluate during the physical examination. An adequate metabolic control could potentially protect patients with diabetes from onychomycosis.