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Pheripheral Arterial Disease in Diabetes.
- 1. PERIPHERAL ARTERIAL DISEASE (PAD) is Partial OR Complete Obstruction of Peripheral Vessels of Upper and Lower Limbs. PAD is the MC Cause of :- • Nonhealing ulcers • Lowerlimb Amputation • Morbidity and Mortality MC Involved Vessel = Dorsalis Pedis Artery
- 2. Clinical Features: 50% Asymptomatic ,10% Intermittent Claudication RISK FACTORS:- Dysfunction of Vascular • Smoking. Endothelium • Diabetes Mellitus. Hallmark of Atherosclerosis in DM • Hypertension • Dyslipidemia , Obesity Intermittent Claudication High Sensitivity CRP Palpation of Vessels Hyperuricemia ABI<0.9 Hyperhomocystinemia
- 7. Classification:- Vascular Infection Metabolic Neuropathic Necrobiotic Treatment related Bullous Miscellanous
- 8. • Diabetic Dermopathy • Rubeosis facei ( diabeticorum) • Ersipelas - like Purpura • Pigmented Purpura • Periungal Telangiectasia VASCULAR
- 9. Diabetic Dermopathy Aka SHIN SPOTS or PIGMENTED PRETIBIAL PAPULES MC cutaneous manifestations in DIABETES (70%) , M>F Multiple shin spots(>4) indicates Microvascular Complications (High Specificity) MORPHOLOGY :- Multiple Bilateral Annular or Irregular erythematous papules or plaques that gradually evolve into atrophic hyperpigmented macules - Resembles POST TRAUMATIC HYPERPIGMENTATION. But NO H/o TRAUMA. MC Site - Shin , Other sites - Thighs , Forearm. HISTOLOGY - Epidermal atrophy with mild dermal inflammation, Microangiopathy with PAS Positive thickening of Vessel Walls . Pigmentation is due to HAEMOSIDERIN DEPOSITION. TREATMENT - Requires No Treatment.
- 11. Rubeosis facei (diabeticorum) Rosy Resdness in face , more obvious in light skinned patients Evident in newly diagnosed diabetics and present in 60% Hospitalized patients with Diabetes.