Background: Cutaneous manifestations in children with type 2 diabetes mellitus is well known. We describe a child with background of poorly controlled type 1 diabetes mellitus who presented with cutaneous lesions posing a diagnostic challenge.
Case: A male child BS, was diagnosed with type 1 diabetes mellitus at the age of 8 yrs. He subsequently developed coeliac disease. He had a background of extensive social problems and had been placed on child protection plan for neglect. His diabetes was generally poorly controlled, with HbA1C values mostly in region of 90 mmol/mol. Three years following diagnosis of type 1 diabetes mellitus he developed cutaneous lesions distributed on his neck, face near the ear as well as behind the ears. These lesions were brown, hyperpigmented, plaque-like with no associated symptoms. Extensive scrubbing with soap and water had not resulted in any change to the lesions. Considering his diabetes background, we re-evaluated the diagnosis of Type 1 diabetes mellitus. He had strongly positive islet cell antibodies, was not obese and there was no family history of type 2 diabetes mellitus. His insulin requirement was appropriate for his age at 0.76 U/kg per day. Hence we concluded that these lesions were unlikely to be acanthosis nigricans and continued management for type 1 diabetes. We sought dermatologists opinion and skin scrapings of the lesion were taken which did not yield a conclusive diagnosis. However, rubbing the lesion with alcohol pads proved effective in removing the lesion entirely. By this intervention we made a diagnosis of Terra Firma-Forme Dermatosis.
Conclusion: This case highlights the importance of considering Terra Firma-Forme Dermatosis as a differential diagnosis for benign localised hyperpigmented lesions. It is relatively rare and readily diagnosed by firmly wiping the lesion with alcohol pads. Prompt recognition of this condition negates unnecessary invasive diagnostic interventions in these patients.
22 - 24 Nov 2017
British Society for Paediatric Endocrinology and Diabetes