---
title: "Ulcerative Bullosis Diabeticorum Linked to Uncontrolled Type 2 Diabetes and Social Barriers"
id: "pubmed-42768731"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42768731"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42768731/"
doi: "10.12659/AJCR.953149"
published_at: "2026-09-22T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Ulcerative Bullosis Diabeticorum Linked to Uncontrolled Type 2 Diabetes and Social Barriers
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42768731
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42768731/)
- **DOI:** [10.12659/AJCR.953149](https://doi.org/10.12659%2FAJCR.953149)
- **Published At:** 2026-09-22T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Bullosis diabeticorum (BD) is a rare dermatologic complication of diabetes with a reported US prevalence of approximately **0.16%–0.5%** among people with diabetes. - The report describes a 41-year-old man with poorly controlled type 2 diabetes mellitus (T2DM), stage II chronic kidney disease, and chronic erectile dysfunction who developed atypical, ulcerative BD. - His HbA1c fluctuated widely (reported range >14% to 7.8%) and was influenced by social determinants of health. - Two months after initial presentation, he developed non-erythematous, nonpainful, nonpruritic blisters that ruptured easily and formed scabs; the largest lesion measured 7.2 × 3.6 × 0.1 cm with yellow slough consistent with ulceration. - Laboratory testing showed an elevated albumin-to-creatinine ratio and decreased estimated glomerular filtration rate, indicating kidney dysfunction. - Diabetes therapy included metformin and titration of basal insulin; erectile dysfunction was treated with phosphodiesterase-5 inhibitors. - There were no clinical signs of wound infection, so wound cultures and antibiotics were not obtained or used. - Testing excluded neuropathy and venous causes of ulceration; however, no skin biopsy or direct immunofluorescence was performed, so the diagnosis remained clinical and based on the history of uncontrolled diabetes. - Wound care ultimately used twice-daily quarter-strength **Dakin's solution** moist-to-dry dressings after initial nonadherence; the patient subsequently showed wound improvement and reduced fasting glucose after one month. - The case emphasizes the interplay between uncontrolled T2DM, multi-organ complications, and social determinants that can affect presentation, diagnosis, and adherence to wound care.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 Department of GME Research, Northeast Georgia Health System, Gainesville, GA, USA. * 2 Department of Family Medicine, Northeast Georgia Health System, Gainesville, GA, USA. * PMID: **42768731** * DOI: [ 10.12659/AJCR.953149 ](https://doi.org/10.12659/ajcr.953149) Item in Clipboard Case Reports # Ulcerative Bullosis Diabeticorum in a Man With Chronic, Uncontrolled Diabetes, Uncontrolled Erectile Dysfunction, and Significant Social Barriers to Care Alexis Burce et al. Am J Case Rep. 2026. Show details Display options Display options Format Abstract PubMed PMID Am J Case Rep Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Am+J+Case+Rep%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Am+J+Case+Rep%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42768731/) . 2026 Sep 22:27:e953149. doi: 10.12659/AJCR.953149. ### Authors [Alexis Burce](https://pubmed.ncbi.nlm.nih.gov/?term=Burce+A&cauthor_id=42768731)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42768731/#short-view-affiliation-1 "Department of GME Research, Northeast Georgia Health System, Gainesville, GA, USA."), [Rediate K Degu](https://pubmed.ncbi.nlm.nih.gov/?term=Degu+RK&cauthor_id=42768731)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42768731/#short-view-affiliation-1 "Department of GME Research, Northeast Georgia Health System, Gainesville, GA, USA."), [Linda N Robles](https://pubmed.ncbi.nlm.nih.gov/?term=Robles+LN&cauthor_id=42768731)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42768731/#short-view-affiliation-2 "Department of Family Medicine, Northeast Georgia Health System, Gainesville, GA, USA."), [Maria Munoz-Bramhall](https://pubmed.ncbi.nlm.nih.gov/?term=Munoz-Bramhall+M&cauthor_id=42768731)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42768731/#short-view-affiliation-2 "Department of Family Medicine, Northeast Georgia Health System, Gainesville, GA, USA."), [Ana Tucker](https://pubmed.ncbi.nlm.nih.gov/?term=Tucker+A&cauthor_id=42768731)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42768731/#short-view-affiliation-1 "Department of GME Research, Northeast Georgia Health System, Gainesville, GA, USA.") ### Affiliations * 1 Department of GME Research, Northeast Georgia Health System, Gainesville, GA, USA. * 2 Department of Family Medicine, Northeast Georgia Health System, Gainesville, GA, USA. * PMID: **42768731** * DOI: [ 10.12659/AJCR.953149 ](https://doi.org/10.12659/ajcr.953149) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract BACKGROUND Bullosis diabeticorum (BD) is a dermatologic, often acral, complication of diabetes, with a reported prevalence of approximately 0.16% to 0.5% among diabetic individuals in the United States. This case reports a man whose presentation was atypical in location and severity, progressing to ulceration. CASE REPORT A 41-year-old man with a history of poorly controlled type 2 diabetes mellitus (T2DM) complicated by stage II chronic kidney disease and chronic erectile dysfunction presented for ongoing management. His HbA1c values ranged from >14% to 7.8%, often influenced by social determinants. Two months later, he presented with blisters with a non-erythematous base (no surrounding erythema) that were non-painful, non-itchy, non-pruritic, and easily ruptured, forming scabs. The largest wound measured 7.2×3.6×0.1 cm, containing yellow slough, consistent with ulcerative BD. Labs showed elevated albumin-to-creatinine ratio and decreased estimated glomerular filtration rate, a measure of kidney function. Diabetes management included metformin and basal insulin titration, while erectile dysfunction treatment included phosphodiesterase-5 inhibitors. With no signs of infection, wound cultures were not obtained and antibiotic therapy was not initiated. Testing excluded neuropathy and venous-related ulcerations. However, as no biopsy or direct immunofluorescence testing was performed, the diagnosis was clinical, and based on a history of uncontrolled diabetes. Wound care transitioned the patient to twice daily quarter-strength Dakin's solution moist-to-dry dressings after initial non-adherence. One month later, the patient's wounds and fasting glucose showed improvement. CONCLUSIONS This case highlights the risks of uncontrolled T2DM with complications, particularly when compounded by social determinants. 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