Bullosis Diabeticorum

CASE A 63-year-old female with insulin-dependent type II diabetes mellitus and end-stage renal disease presented to the emergency department with spontaneous blistering to the tips of her left index and middle fingers. The blisters had gradually become tense and mildly painful over the preceding 10 days. She denied burn injury, trauma, fever, or new medications. On physical exam, the patient was noted to have a tense, nontender bullae on the pad of the left middle finger, and a collapsed, hemorrhagic bullae on the left index finger. There were no signs of inflammation or infection. A radiograph of the left hand, complete blood count, and basic metabolic panel were unremarkable. The diagnosis of bullosis diabeticorum was made, and supported by a consulting endocrinologist.