Acquired palmoplantar keratoderma (PPK) is a rare dermatologic condition associated with systemic diseases, including uncontrolled diabetes mellitus.

Iqbal et al. report the case of a 53-year-old woman with suboptimally controlled type 2 diabetes who presented with diabetic ketoacidosis (DKA; glucose 40mmol/l, ketones 7mmol/l) and septic shock, secondary to a methicillin-sensitive Staphylococcus aureus necrotising soft tissue infection. Her history included intellectual impairment and long-standing, poorly controlled diabetes managed with insulin. On examination, she was found to have severe plantar keratoderma and onychogryphosis, which had progressively worsened over 2 years. Glycated haemoglobin was raised (10.4%, 90 mmol/mol) with negative diabetes antibodies (anti-insulin and anti-glutamic acid decarboxylase), consistent with poorly controlled type 2 diabetes. Magnetic resonance imaging confirmed a necrotising back wound, which was managed with i.v. antibiotics and debridement.

She was managed for DKA and switched to twice-daily mixed insulin and metformin on discharge. For her PPK, she was prescribed 40% urea cream, resulting in gradual improvement. This case highlights the importance of regular dermatologic assessments in diabetes care to detect and manage rare complications such as PPK.

Read the full article in Endocrinology, Diabetes & Metabolism Case Reports EDM-24-0088 https://doi.org/10.1530/EDM-24-0088