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STUDII CLINICE I EXPERIMENTALE

CLINICAL AND EXPERIMENTAL STUDIES

XEROZA CUTANAT LA PACIENII CU DIABET ZAHARAT


STUDIU CAZ-MARTOR
DIABETES MELLITUS PATIENTS WITH XEROTIC SKIN
- A CASE AND CONTROL STUDY -

ANCA CRCIUN*, MIRELA MOLDOVAN**, FLORINA SLJAN**, C. VLAD**, AL. TTARU***


Cluj-Napoca
Rezumat

Obiectiv: Diabetul zaharat este o boal sistemic, ce


afecteaz n timp toate organele. Obiectivul nostru primar
a fost s aflm dac diabetul zaharat afecteaz gradul de
hidratare cutanat, comparativ cu un lot de control.
Obiectivul secundar a fost s aflm dac pacienii
insulinotratai au un grad de xeroz cutanat mai avansat
dect diabeticii tratai cu antidiabetice orale (ADO).
Material i metod: Au participat la acest studio 44
de pacieni diabetici i 41 de subieci de control. A fost
msurat gradul de hidratare cutanat a stratului cornos
(SC) cu ajutorul Corneometer CM 825 n trei puncte:
faa volar a antebraului stng, faa antero-lateral a
coapsei stngi i faa dorsal a piciorului stng.
Rezultate: Pacienii diabetici au avut un grad de
hidratare semnificativ mai redus la nivelul antebraului fa de
lotul de control. Nu a existat diferen semnificativ statistic
ntre lotul de control i diabetici tratai cu ADO. Diabeticii
insulinotratai au avut tegumentul semnificativ mai
deshidratat fa de martori la nivelul antebraului i al coapsei.
Comparnd subiecii sntoi cu diabeticii tip 1, am obinut
semnificaie statistic la nivelul antebraului i coapsei,
diabeticii fiind mai deshidratai. Diabeticii tip 2 au tegumentul
mai deshidratat la nivelul antebraului fa de lotul de control.
Nu a existat diferen semnificativ statistic ntre grupurile de
diabetici la niciunul dintre punctele de msurare.
Concluzii: Diabetul afecteaz coninutul de ap al
tegumentului. Diabeticii insulinotratai sunt mai afectai
dect diabeticii tratai cu terapie oral. Nu exist diferene
ntre diabetici tip 1 sau 2 n ceea ce privete coninutul de
ap al SC.
Cuvinte cheie: diabet zaharat, hidratate, xeroz
cutanat, strat cornos, corneometrie.

Summary

Objectives: Diabetes mellitus is a systemic disease


which affects in time all the organs. Our primary objective
was to measure water content of the skin of diabetic patients
and to compare it with healthy non-diabetic controls. The
secondary objective was to determine if the insulino-treated
patients have a more severe grade of cutaneous xerosis as
compared to diabetic patients treated with oral medication.
Material and Methods: This case-control study was
conducted on 44 diabetic patients and 41 controls. We
measured the stratum corneum (SC) hydration using
Corneometer CM 825, in 3 sites: the volar side of the
forearm, the front-lateral side of the left hip and the dorsal
side of the foot.
Results: The diabetic patients had a lower hydration of
the forearm than controls. There was no difference between
controls and diabetic patients treated orally. The insulinotreated patients had a lower hydration than controls in hip,
and in hip when compared to diabetic patients treated by
oral therapy. When we compared patients with type 1
diabetes and controls, the diabetics had a lower hydration in
forearm and hip. Type 2 diabetic patients have a lower
hydration on the forearm than controls. There was no
difference between type 1 and 2 diabetic patients.
Conclusion: Diabetes affects the water content of the
skin. The insulino-treated patients are more affected than
the diabetic patients treated with oral therapy. There is no
difference between type 1 and type 2 diabetic patients
regarding the water content of SC.
Keywords: diabetes mellitus, hydration, cuteneous
xerosis corneum, corneometry.

DermatoVenerol. (Buc.), 55: 79-87

* Centrul de Diabetologie Cluj-Napoca.


** Catedra de Dermatologie-Cosmetic, Facultatea de Farmacie, U.M.F. Cluj-Napoca.
*** Clinica de Dermatologie, U.M.F. Cluj-Napoca.

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DermatoVenerol. (Buc.), 55: 79-87

Introducere

Diabetul zaharat este responsabil pentru


multiple afectri ale tegumentului, unele studii
indic o legtura ntre diabet i diverse
manifestri cutanate variind ntre 11,4% i 71%
[1]. Xeroza cutanat este cea mai frecvent
afectare non-infecioas a tegumentului la
pacienii cu diabet zaharat [2]. Pacienii diabetici
prezint frecvent xeroz cutanat la nivelul
plantelor, mai ales la nivelul calcielor. ntr-un
studiu ce a cuprins 352 de pacieni diabetici,
82,1% dintre acetia aveau xeroz cutanat i
fisuri la nivelul plantelor [3]. Netratat, xeroza
cutanat crete riscul complicaiilor, cum ar fi
infecia, ulceraiile i mai ales formarea de calus.
Xeroza cutanat este frecvent ntlnit n
populaia general. Este o problem pentru
5985% dintre cei cu vrste peste 64 ani [4], fiind
una dintre cele mai frecvente afeciuni noninfecioase i la pacienii cu diabet zaharat. Datele
din literatur sugereaz c prezena xerozei
cutanate crete riscul de infecii i ulcere de
presiune [5-7]. Poate s apar n orice regiune a
corpului, mai vulnerabil fiind faa, minile,
plantele, gleznele i axilele. Dac filmul lipidic de
la suprafaa tegumentului este ndeprtat, pielea
devine uscat, putnd s se fisureze i s se
infecteze. Ulcerele de presiune sunt arii limitate
de distrucie tisular cauzate de compresia
esutului moale ntre o proeminen osoas i o
suprafa extern dur, pe o perioad mai lung
de timp. Stratul cornos deshidratat este precursorul ulcerului de presiune, fiind dovedit c
aceste ulcere pot fi prevenite prin aplicarea de
hidratante ale stratului cornos [8-9].
Xeroza cutanat, alturi de formarea calusului, joac un rol cheie n patologia piciorului
diabetic, una dintre complicaiile majore ale
diabetului zaharat, dup cum arat un articol
publicat n noiembrie 2006 [10].
Cauzele comune ale xerozei cutanate sunt:
scderea hidratrii, utilizarea apei fierbini
pentru igiena personal, utilizarea spunului cu
pH acid, ncrctura genetic, naintarea n
vrst, factori ambientali (poluare, frig, scderea
umiditii aerului). Xeroza cutanat poate s fie
produs i de condiiile patologice, cum ar fi
dermatita atopic, malnutriia, insuficiena renal
sau diabetul zaharat.

80

Introduction

Diabetes is responsible for multiple impaired


skins, studies concerning the connection between
diabetes and various cutaneous manifestations
showing damage in proportions ranging between
11.4% and 71% [1]. Xerotic skin is the most
common non-infectious skin damage in patients
with diabetes [2]. Diabetic patients often present
cutaneous xerosis of the soles, especially in the
heels. In a study that included 352 diabetic
patients, 82.1% of them had skin xerosis and
cracks in the soles [3]. Untreated, xerotic skin
increases the risk of complications such as
infection, ulceration and especially the formation
of callus.
Xerotic skin is common in the general
population. It is a problem for 59-85% of those
aged over 64 years [4], is one of the most common
non-infectious diseases and frequent in diabetes
mellitus patients. The literature suggests that
xerotic skin increases the risk of infections and
pressure ulcers [5-7]. It may occur in any region
of the body; the more vulnerable are the face,
hands, soles, ankles and axillae. If the lipid film
from the surface skin is removed, the skin
becomes dry, cracked and liable to infection.
Pressure ulcers are limited areas of tissue
destruction caused by compression of soft tissue
between a prominent bone and an external
surface over a long period of time. Dehydrated
stratum corneum is the precursor of pressure
ulcers; there is evidence that these ulcers can be
prevented by applying hydrating lotions on the
stratum corneum [8-9].
Cutaneous xerosis, along with callus
formation, plays a key role in diabetic foot
pathology, one of the major complications of
diabetes, according to an article published in
November 2006 [10].
Most common causes of skin xerosis are:
reduction of hydration, use of hot water for
personal hygiene, using soap with acid pH,
genetic load, age, ambient factors (pollution, cold
weather, decreasing air humidity). Xerotic skin
can appear under pathological conditions such as
atopic dermatitis, malnutrition, renal failure or
diabetes.
Pruritus leads to tegument damage by
scratching, followed by inflammations or
cutaneous lesions. Secondly, ambient allergens

DermatoVenerol. (Buc.), 55: 79-87

Pruritul duce la lezarea tegumentului prin


grataj, urmat de inflamaie sau leziuni cutanate.
Secundar, alergeni ambientali i ageni patogeni
pot ptrunde n tegument, crescnd riscul de
apariie a dermatitei de contact i a infeciilor.
Se cunoate semnificaia insulinei ca factor de
cretere vital n culturile de keratinocite i
importana acesteia n proliferarea, migrarea i
diferenierea keratinocitelor n epiderm al pacienilor cu diabetul duce la alterarea funciilor
stratului cornos [11].
Acestea fiind tiute, obietivul nostru primar a
fost s aflm dac diabetul zaharat afecteaz
gradul de hidratare cutanat, comparativ cu un
lot de control. Obiectivul secundar a fost s aflm
dac pacienii insulinotrani au un grad de xeroz
cutanat mai avansat dect diabeticii tratai cu
antidiabetice orale (ADO) i dac exist diferen
n ceea ce privete gradul de hidratare ntre
diabeticii tip 1 i cei cu tip 2.

and pathogens can penetrate the skin, increasing


the risk of contact dermatitis and infections.
The significance of insulin as growth factor
vital in keratinocyte cultures is well known, as
well as its importance in the proliferation,
migration and differentiation of epidermal
keratinocytes in patients with diabetes leads to
impaired stratum corneum [11].
Consequently, our primary objective was to
find out if diabetes affects the degree of skin
hydration as compared to a control group. The
secondary objective was to find out if insulintreated patients have a higher degree exposure to
cutaneous xerosis thant patients treated with oral
anti-diabetics (ADO) and if there are differences
in the degree of hydration between diabetes type
1 and type 2.

Patients and Method

La studiu au participat 44 de pacieni


diagnosticai de minim 6 luni cu diabet zaharat
de tip 1 sau tip 2 n comformitate cu criteriile
ADA (2006) [12] [tabelul 1], acetia alctuind lotul
de studiu. Lotul de control a fost alctuit din 41
de martori, ajustai pentru vrst i gen.
Msurarea gradului de hidratare s-a fcut n
trei puncte: faa volar a antebraului stng, faa
antero-lateral a coapsei stngi i faa dorsal a
piciorului stng. nainte de msurare, participanii au fost climatizai timp de aproximativ
15 minute la temperatura de 2024C i umiditate
de 3045%. n ultimele trei ore participanii nu

The study recruited 44 patients diagnosed at


least 6 months before with diabetes mellitus type
1 or type 2, according to ADA criteria (2006) [12]
[Table 1], these forming the study group. Control
group was composed of 41 people of appropriate
age and sex.
Measuring the degree of hydration was made
on three points: volar side of left forearm,
anterolateral side of left hip and dorsal side of left
foot. Before measurement, participants were kept
for about 15 minutes at 20-240C and humidity
of 30-45%. In the last three hours the participants
were not allowed to wash with soap and water on
body sites to be measured.
Cutaneous hydration degree of stratum
corneum was determined by conometry using

Tabelul I. Criteriile ADA de diagnostic ale diabetului


zaharat [12]

Table I. ADA criteria in the diagnosis


of diabetes mellitus [12]

Pacieni i Metod

Simptome sugestive pentru diabet (poliurie, polidipsie,


scderea inexplicabil n greutate) plus o valoare a
glicemiei plasmatice la o determinare ocazional
(indiferent de timpul scurs de la ultima mas)
200 mg/dl (11.1 mmol/l);

Symptoms suggesting diabetes (poluuria, polydypsia,


unaccountable loss of weight) plus a value of plasma
glycemia in occasional determination
(irrespective of time lapsed from last meal) 200 mg/dl
(11.1 mmol/l);

sau glicemia la 2 ore dup administrarea per os a 75g


glucoz anhidr dizolvat n ap 200mg/dl
(11,1 mmol/l).

or glycemia two hours after administration per os of 75 g


of water solved 200mg/dl (11,1 mmol/l).

sau glicemia a jeun 126 mg/dl (7 mmol/l)*<

A jeun nseamn lipsa oricrui aport alimentar n ultimele 8 ore.

or glycemia a jeun 126 mg/dl (7 mmol/l)*<

A jeun = lack of any food supply for the last 8 hours.

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DermatoVenerol. (Buc.), 55: 79-87

s-au splat cu ap i spun la nivelul locurilor de


msurare.
Gradul de hidratare cutanat a stratului
cornos a fost determinat prin conometrie cu
ajutorul Corneometer CM 825 (CourageKhazaka Electromic GmbH, Germania) [fig. 1].
Principiul pe care se bazeaz msurtorile
efectuate cu corneometrul este msurarea capaticitantei unui mediu dielectric. Stratul cornos
este un mediu dielectric dependent de coninutul
su de ap.

Corneometer CM 825 (Courage-Khazaka


ElectroMic GmbH, Germany) [Figure 1]. The
principle behind the gauges made by corneometer is the measurement of capacitance of a
dielectric medium. Stratum corneum is a
dielectric environment dependent on its water
content.
A big advantage of this method is that in
comparison with other devices, products applied
to the skin have a minimal influence on the
measurements. The values determined are very

Fig. 1. Msurarea hidratrii cutanate


cu ajutorul Corneometer CM 825
Fig. 1. Measurement of skin hydration
by Corneometer CM 825

Un mare avantaj al acestei metode este c, n


comparaie cu alte dispozitive, produsele aplicate
pe piele au o influen minim asupra
msurtorilor. Valorile determinate sunt foarte
sensibile, reproductibile, iar durata msurtorii
este foarte scurt (1 secund). Designul dispozitivului de msurare a fost conceput astfel
nct profunzimea msurtorilor s fie foarte
mic (10-20 m ai stratului cornos). Acest lucru
este foarte important dac se dorete msurarea
gradului de hidratare al epidermului, deoarece
dac profunzimea determinrii ar fi mai mare ar
putea interfera cu vasele de snge ce trec prin
straturile mai profunde ale tegumentului i ar
modifica valoarea msurtorii.
Datele obinute au fost analizate cu software
SPSS-13.0, utiliznd testul t pentru variabile
independente (am considerat semnificative din

82

sensitive, reproducible, and the length measurement is extremely short (1 second). The
measuring device was designed in such a way as
to allow shallow measurement (10-20m of the
stratum corneum). This is very important if we want to
measure the degree of hydration of the epidermis
since deeper determination could interfere with
blood vessels passing through the deeper layers
of skin, changing the values of reading.
The data were analyzed with SPSS-13.0
software, using t test for independent variables
(we considered statistically significant a p value
less than 0.05). The study was approved in
advance by the Ethics Committee of Iuliu
Haeganu University of Medicine and
Pharmacy, being conducted in compliance with
the principles of the Declaration of Helsinki. All

DermatoVenerol. (Buc.), 55: 79-87

punct de vedere statistic o valoare a p mai mic


de 0.05). Studiul a fost aprobat n prealabil de
ctre Comisia de Etic a U.M.F. Iuliu
Haieganu, fiind desfurat respectnd principiile Declaraiei de la Helsinki. Toi pacienii au
fost informai despre studiu i au semnat n
prealabil Formularul de Consimmnt Informat.

Rezultate

La studiu au participat 44 de pacieni


diagnosticai de minim 6 luni cu diabet zaharat
tip 1 sau tip 2. Lotul de control a fost alctuit din
41 de martori, ajustai pentru vrst i gen.
Vrsta medie lotului de studiu a fost de 53,07
ani, cu o deviaie standard de 12,13 ani. Vrsta
medie lotului de studiu a fost de 52,24 ani cu o
deviaie standard de 12,97. Cele 2 grupuri au
fost comparabile n ceea ce privete parametrul
vrsta, p nefiind semnificativ statistic (p = 0,76).
Lotul de studiu a cuprins 44 de subieci,
dintre care 14 brbai (31,82%) i 30 de femei
(68,18%), iar lotul de control a fost alctuit de
41 de participani, 13 au fost brbai (31,7%), iar
28 au fost femei (68,3%) [fig. 2].
n lotul de studiu au fost inclui att pacienii
diagnosticai cu tip 1 (11 din 41 de subieci, adic
26,8%), ct i cu tip 2 (30 din 41, adic 73,2%). n
ceea ce privete farmacoterapia diabetului, 75,6%
dintre participanii la studiu au fost insulinotratai (31 din 41de subiecti), iar restul de 24,4%
au fost tratai cu antidiabetice orale (10 din 41 de
subieci) [fig. 3].

patients were informed about the objectives of


the study and signed informed consent form in
advance.

Results

The study was conducted on 44 patients


diagnosed at least 6 months before with type 1 or
type 2 diabetes mellitus. Control group was
composed of 41 people of appropriate age and
sex.
The average age of control group was 53.07
years, with a standard deviation of 12.13 years.
The average age of study group was 52.24
years, with a standard deviation of 12.97. The
2 groups were comparable in terms of age
parameter, p not statistically significant (p = 0.76).
The study included 44 subjects, of whom 14
men (31.82%) and 30 women (68.18%), and the
control group was composed of 41 participants,
13 male (31.7 %), and 28 female (68.3%)[Fig. 2].
The study group included both patients
diagnosed with diabetes type 1 (11 of 41 subjects,
ie 26.8%), and with type 2 (30 of 41, ie 73.2%). In
terms of diabetes pharmacotherapy, 75.6% of
study participants were insulin-treated (31 out of
41 subjects), and the remaining 24.4% were
treated with oral agents (10 of 41 subjects)
[Figure 3].
When the degree of hydration of the skin was
compared between the two lots, statistically
significant differences resulted only in the

Fig. 2. mprirea pe sexe a lotului de studiu i a lotului de control


Fig. 2. Sex distribution in study and control groups

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DermatoVenerol. (Buc.), 55: 79-87

Fig. 3. mprirea dup titlu de diabet a lotului de studiu


Fig. 3. Distribution by way of diabetes type
of study group patients

Cnd a fost comparat gradul de hidratare al


tegumentului ntre cele duo loturi, nu s-a
obinut semnificaie statistic dect la nivelul
antebraului (p = 0,008), la nivelul coapsei i a
piciorului neavnd semnificaia statistic
(p = 0,114, respectiv p = 0,168) [tabelul II].
Nu a existat semnificaia statistic la nici un
loc de determinare ntre subiecii sntoi i

forearm (p = 0.008), not in the thigh (p = 0.114)


and the leg (p = 0.168) [Table II].
No statistical significance was determined in
any part of the body in healthy subjects as
compared to diabetics treated with oral agents (p
= 0.347 in the foot and p = 0.622 in the thigh). If
we compare healthy subjects with insulin-treated
diabetics, the latter have a significantly lower

Tabel II. Comparaie ntre gradul de hidratare cutanat ntre diferite grupuri
Locul determinrii

Faa volar antebra stng

Faa antero-lateral a coapsei stngi

Faa dorsal a piciorului stng

84

Loturile care se compar

Diabetici vs. martori


Diabetici tratai cu ADO vs. martori
Diabetici insulinotrani vs. martori
Diabetici tratai cu ado vs. diabetici insulinotrani
Diabetici tip.1 vs. martori
Diabetici tip.2 vs. martori
Diabetici tip. 1 vs diabetici tip.2
Diabetici vs. martori
Diabetici tratai cu ADO vs. martori
Diabetici insulinotrani vs. martor
Diabetici tratai cu ado vs. diabetici insulinotrani
Diabetici tip.1 vs. martor
Diabetici tip.2 vs. martori
Diabetici tip. 1 vs diabetici tip.2
Diabetici vs. martori
Diabetici tratai cu ADO vs. martori
Diabetici insulinotrani vs. martor
Diabetici tratai cu ado vs. diabetici insulinotrani
Diabetici tip.1 vs. martor
Diabetici tip.2 vs. martori
Diabetici tip. 1 vs diabetici tip.2

Semnificaia statistic (p)


0.008
0.07
0.009
0.92
0.011
0.016
0.065
0.114
0.622
0.015
0.042
0.002
0.328
0.017
0.168
0.347
0.209
0.919
0.560
0.153
0.595

DermatoVenerol. (Buc.), 55: 79-87


Table II. Comparison of skin hydration levels in various groups
Determination site

Left forearm volar side

Antero-lateral side
of left thigh

Dorsal side of left foot

Groups compared

Diabetics vs. control group


Diabetics treated with ADO vs. control group
Diabetics insulin-treated vs. control group
Diabetics treated with ADO vs. insulin-treated diabetics
Diabetics type.1 vs. control group
Diabetics type.2 vs. control group
Diabetics type. 1 vs Diabetics type. 2
Diabetics vs. control group
Diabetics treated with ADO vs. control group
Insulin-treated diabetics vs. control group
Diabetics treated with ADO vs. insulin-treated diabetics
Diabetics type.1 vs. control group
Diabetics type. 2 vs. control group
Diabetics type. 1 vs. diabetics type.2
Diabetics vs. control group
Diabetics treated with ADO vs. control group
Insulin-treated diabetics vs. control group
Diabetics treated with ADO vs. insulin-treated diabetics
Diabetics type.1 vs. control group
Diabetics type.2 vs. control group
Diabetics type. 1 vs. diabetics type. 2

diabeticii tratai cu antidiabetice orale (p = 0,347


la nivelul piciorului i p = 0,622 la nivelul
coapsei). Dac am comparat subiecii sntoi cu
diabeticii insulinotrani, cei din urm au un grad
de hidratare semnificativ mai redus la nivelul
antebraului i al coapsei (p = 0,009, respectiv
p = 0,015).
A existat diferen statistic n ceea ce
privete gradul de hidratare cutanat dac am
comparat diabeticii insulinotrani cu diabeticii
tratai cu antidiabetice orale doar la nivelul
coapsei (p = 0,042), (p = 0,0927 la nivelul
antebraului, p = 0,0919 la nivelul piciorului).
Comparnd subiecii sntoi cu diabeticii tip
1, am obinut semnificaie statistic la nivelul
antebraului i coapsei, diabeticii fiind mai
deshidratai (p = 0,011, respective 0,002).
Diabeticii tip 2 au tegumentul mai deshidratat la
nivelul antebraului fa de lotul de control (p =
0,016). Nu a existat diferen semnificativ
statistic ntre grupurile de diabetici la niciunul
dintre punctele de msurare.

Discuii

Tegumentul este cunoscut ca un organ


glicolitic. Keratinocitele exprim receptori
insulinici, avnd un sistem de preluare a glucozei

Statistical significance (p)


0.008
0.07
0.009
0.927
0.011
0.016
0.065
0.114
0.622
0.015
0.042
0.002
0.328
0.017
0.168
0.347
0.209
0.919
0.560
0.153
0.595

degree of hydration on the forearm and the thigh


(p = 0.009, respectively p = 0.015).
There was statistical difference in the degree
of skin hydration in insulin-treated diabetics
compared with diabetics treated with oral agents
only in the thigh (p = 0.042), (p = 0.0927 in the
forearm, p = 0.0919 at leg level).
Comparing healthy subjects with type 1
diabetics, we obtained statistical significance in
the forearm and thigh, diabetic patients being
more dehydrated (p = 0.011, respectively 0.002).
Patients with diabetes type 2 showed more
dehydrated skin in the forearm as compared to
the control group (p = 0.016). There was no
statistically significant difference between
diabetic groups at any of the points of
measurement.

Discussions

The skin is an organ known as glycolytic.


Keratinocytes express insulin receptors, with a
reception system of glucose in an insulindependent manner [14]. Studies published over
15 years ago suggested that insulin stimulates
keratinocyte migration and proliferation [15-16].
Another study, directed in the year 2000, showed

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DermatoVenerol. (Buc.), 55: 79-87

ntr-o maniera insulin-dependent [14]. Studii


publicate n urm cu peste 15 ani sugerau faptul
c insulina stimuleaz migrarea i prolifierea
keratinocitelor [15-16]. Un al studiu n anul 2000
a demonstrat faptul c insulina i factorul-1 de
cretere insulin-like au rol n diferenierea
keratinocitelor [17]. Aadar, insulina joac un rol
vital n proliferarea, migrarea i diferenierea
keratinocitelor, motiv pentru care ne ateptm ca
la diabetul zaharat s apar unele modificri ale
proprietilor fizice ale tegumentului. ntr-un
studiu [11] Sakai et al. a obinut rezultate care
sugerau scderea gradului de hidratare cutanat
la nivelul antebraului la diabetici n general, fa
de lotul de control.
ntr-un alt studiu efectuat de Sakai et al. [18],
de aceast dat pe oareci cu diabet indus cu
streptozocin (care duce la apariia unui diabet
insulino-dependent) s-a observat scderea apei din
stratul cornos. n studiul nostru am observat de
asemenea c diabeticii insulinotrani au
tegumentul mai deshidratani fa de martori att
la nivelul antebraului ct i al coapsei, iar fa de
diabeticii tratai cu ADO au tegumentul mai
deshidratai la nivelul coapsei. Nu a existat nici o
diferen la nivelul coapsei. Nu a existat nici o
diferen n ceea ce privete gradul de hidratare
ntre martori i diabeticii tratai cu ADO. Diabeticii
tip 1, care sunt exclusiv insulinotrani, au
caracteristicile grupului insulinotrant. Diabeticii
tip 2 sunt tratai cu ADO pentru o perioada de
timp, ulterior devenind insulino-trani, deci sunt
un grup mixt. Cnd am comparat diabeticii tip 2
cu lotul martor am obinut un grad de hidratare
semnificativ mai redus la nivelul antebraului, dar
nu a existat diferen semni-ficativ statistic ntre
grupurile de diabetici tip 1 sau tip 2.

Concluzii

Diabetul zaharat, indifferent de tipul acestuia,


produce o afectare a hidratrii stratului cornos, cel
puin n anumite regiuni ale corpului, afectarea
fiind mai sever la diabeticii insulino-trani.
Diabeticii tratai cu antidiabetice orale au un
grad de hidratare comparabil cu lotul de control,
una dintre explicaii find faptul c este prezent
nc o secreie endogen suficient de insulin,
diferenierea, migrarea i proliferarea keratinocitelor fiind afectat n studiul insulinonecesitant.
Intrat n redacie: 21.12.2009

86

that insulin and insulin growth factor-1-like have


a role in keratinocyte differentiation [17].
Therefore, insulin plays a vital role in the
proliferation, migration and differentiation of
keratinocytes, which is why we expect some
changes in the physical properties of skin to
appear in diabetes. Sakai et al. obtained results
suggesting the decrease of the degree of
hydration in the forearm skin in diabetics in
general, as compared with control subjects [11].
In another study conducted by Sakai et al.
[18], this time on mice with diabetes induced by
streptozocin (giving rise to an insulin-dependent
diabetes) water level drop occur in the stratum
corneum. In our study we also noticed that
insulin-treated diabetics have more dehydratation skin as compared to control group
both in the forearm and in the thigh, and at thigh
level by comparison with ADO treated subjects.
There was no difference in the thigh. There was
no difference in the degree of hydration between
control group and diabetics treated with ADO.
Type 1 diabetics, who are exclusively insulintreated, display characteristics of insulin-treated
subjects. Type 2 diabetics treated with ADO for a
period of time, later turn to insulin treatment, so
are a mixed group. When comparing type 2
diabetics with controls we have obtained a
significantly lower hydration in the forearm, but
no statistically significant differences were noted
between type 1 and type 2 diabetics.

Conclusions

Diabetes mellitus, regardless of its type,


produces an impaired stratum corneum
hydration, at least in certain parts of the body.
Damage is more severe in insulin-treated
diabetics.
Diabetics treated with oral agents had a
comparable degree of hydration with the control
group, one of the explanations being that there
still is a sufficient secretion of endogenous
insulin, the differentiation, migration and
proliferation of keratinocytes being affected in
the insulin-dependent cases.
Received: 21.12.2009

DermatoVenerol. (Buc.), 55: 79-87

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