Diabetes mellitus and autoimmune skin diseases

Autoimmune diseases of dermatological interest can be classified as organ-specific and systemic. These relatively rare skin diseases, such as vitiligo and alopecia areata, have a complex pathogenesis and may might be associated with other autoimmune diseases including type 1 diabetes. Vitiligo is an acquired disease of pigmentation caused by destruction of melanocytes. The prevalence ranges from 0.5 to 2.0% of the general population, and it is more common in childhood. Alopecia areata, another autoimmune skin disorder, causes patchy hair loss mainly on the scalp, but may involve other areas as well, and usually appears in young people under 20 years old. Approximately 4% of diabetic patients have concomitant celiac disease, hence also its skin manifestations, namely dermatitis herpetiformis. Other immune-mediated skin disorders such as psoriasis are associated with metabolic syndrome and type 2 diabetes, with increasing risk for cardiovascular diseases. Hydradenitis suppurativa/acne inversa (HS) is another debilitating chronic inflammatory skin disorder with an unknown etiology that is commonly associated with dysmetabolic diseases. These patients, with their intrinsically higher risk of metabolic comorbid conditions, need holistic management.