Diabetic pruritus L29.8

Mostly on feet and lower legs beginning, later also generalized, rarely genitoperianal itching in diabetics. Persistence of itching despite cessation of diabetes is possible.

Chronic pruritus occurs in diabetics with a frequency of 3-49%. Generalized pruritus was demonstrated in a larger study (n=385 patients) in 27.5% of diabetic patients (type II diabetes) (Ko MJ et al.2013).

The cause of diabetogenic pruritus is often a small fiber neuropathy (see Small Fiber Neuropathy) with damage to the myelinated ad- and non-myelinated C-fibers). Decreased nerve fiber density has been demonstrated in skin biopsies from patients with diabetes. Patients with highly pathological postprandial glucose levels suffered more frequently from generalized pruritus, an indication of its pathogenetic significance.

Aggravatingly, xerosis cutis is frequently found (due to age and hypohidrosis in diabetic autonomic neuropathy). Furthermore, pruritus may be triggered by certain drugs (glimepiride, metformin and tolbutamide).

Clinically, a generalized pruritus without primary skin lesions is clinically impressive. Chronification may lead to a secondary clinical picture of a nodular prurigo. In contrast, diabetics with localized pruritus should be excluded from skin infections (e.g. intertriginous candidiasis).

Diabetic pruritus caused 24.5% of the patients to have difficulty falling asleep, 15.1% suffered from sleep disturbances and 9.5% needed sleeping pills.

Menthol or polidocanol-containing topicals 1-2 times/day can provide relief(Menthol cream 5%, R200). Also Polidocanol-containing shaking mixtures or emulsions R200. In any case a test with UVB or UVA1 is indicated. Furthermore, a test with glucocorticoid ointments or emulsions is recommended(R123 R030).

1. Asokan N et al (2017) Cutaneous problems in elderly diabetics: A population-based comparative cross-sectional survey. Indian J Dermatol Venereol Leprol 83:205-211.
2. Bustan RS det al. (2017) Specific skin signs as a cutaneous marker of diabetes mellitus and the prediabetic state - a systematic review. Dan Med J 64. pii: A5316.
3. Ko MJ et al (2013) Postprandial blood glucose is associated with generalized pruritus in patients with type 2 diabetes. Eur J Dermatol 23:688-693.
4. Lima AL et al (2017) Cutaneous Manifestations of Diabetes Mellitus: A Review. At J Clin Dermatol 18:541-553.