Newly diagnosed type II diabetes mellitus presenting with localized itch

Talib Mearza, Wesam Abou Amer, Maryam Al Jaber


Type II diabetes is caused by insulin resistance resulting in high blood sugar levels. Although the typical symptoms of diabetes are described as polyuria, polydipsia and fatigue as many as 60% of newly diagnosed patients with type II diabetes are asymptomatic. Here authors present a case of a 39-year-old male patient who presented with localized pruritus affecting the medial aspects of his forearms and upper legs as the sole symptom of newly diagnosed type II diabetes mellitus. The itch symptom markedly improved on significantly reducing his dietary intake of sugars and with the use of metformin. Authors hope to alert clinicians to consider the possibility of underlying diabetes in such presentations to enable swift diagnosis and consequent treatment. It is unusual to find patients presenting with localized itch without any corresponding cutaneous manifestations as a presentation of type II diabetes.


Itch, Localized, Pruritus, Type 2 diabetes

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CDC. Fact sheet: Type 2 diabetes. Available at: Accessed February 2020.

Diabetes UK. Signs and symptoms of type 2 diabetes. Available at: Accessed February 2020.

Demirseren DD, Emre S, Akoglu G, Arpacı D, Arman A, Metin A, et al. Relationship between skin diseases and extracutaneous complications of diabetes mellitus: clinical analysis of 750 patients. Am J Clini Dermatol. 2014 Feb 1;15(1):65-70.

Etter L, Myers SA. Pruritus in systemic disease: mechanisms and management. Dermatol Clini. 2002 Jul;20(3):459-72.

Weisshaar E, Fleischer Jr AB, Bernhard JD, Cropley TG. Pruritus and dysesthesia. In: Bolognia JL, Jorizzo JL, Schaffer JV eds. Dermatology, 3rd ed. Elsevier; 2012: 111-20.

Stefaniak A, Chlebicka I, Szepietowski J. Itch in diabetes: a common underestimated problem. Adv Dermatol Allergol. 2019 Nov;36(1):1-7.

Yamaoka H, Sasaki H, Yamasaki H, Ogawa K, Ohta T, Furuta H, et al. Truncal pruritus of unknown origin may be a symptom of diabetic polyneuropathy. Diabetes care. 2010 Jan 1;33(1):150-5.

Valdes-Rodriguez R, Mollanazar NK, González-Muro J, Nattkemper L, Torres-Alvarez B, López-Esqueda FJ, et al. Itch prevalence and characteristics in a Hispanic geriatric population: a comprehensive study using a standardized itch questionnaire. Acta dermato-venereologica. 2015 Apr 1;95(4):417-21.

Ko MJ, Chiu HC, Jee SH, Hu FC, Tseng CH. Postprandial blood glucose is associated with generalized pruritus in patients with type 2 diabetes. European J Dermatol. 2013 Sep 1;23(5):688-93.

Qatar Government Portal. Diabetes Topics. Available at: Accessed February 2020.

American Diabetes Association. Pharmacological Approaches to Glycemic Treatment:Standards of Medical Care in diabetes- 2020. Available at: Accessed February 2020.

American Diabetes Association. Skin complications. Available at: Accessed February 2020.

Krajnik M, Zylicz Z. Understanding pruritus in systemic disease. J Pain Symptom Manag. 2001 Feb 1;21(2):151-68.

SCRIBNER M. Diabetes and pruritus of the scalp. JAMA. 1977 Apr 11;237(15):1559.

Hahler B. An overview of dermatological conditions commonly associated with the obese patient. Ostomy/Wound Manag. 2006 Jun;52(6):34-6.

Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequences. The Am J Clini Nutri. 2008 Apr 1;87(4):1080S-6S.

Su O, Bahalı AG, Demir AD, Ozkaya DB, Uzuner S, Dizman D, et al. The relationship between severity of disease and vitamin D levels in children with atopic dermatitis. Adv Dermatol Allergol. 2017 Jun;34(3):224.

National Health Service UK. Non-alcoholic liver disease. Available at: Accessed February 2020.

Oeda S, Takahashi H, Yoshida H, Ogawa Y, Imajo K, Yoneda M, et al. Prevalence of pruritus in patients with chronic liver disease: a multicenter study. Hepatol Re. 2018 Feb;48(3):E252-62.

Kremer AE, Beuers U, Oude-Elferink RP, Pusl T. Pathogenesis and treatment of pruritus in cholestasis. Drugs. 2008 Oct 1;68(15):2163-82.

Rajagopalan M, Saraswat A, Godse K, Shankar DK, Kandhari S, Shenoi SD, et al. Diagnosis and management of chronic pruritus: an expert consensus review. Ind J Dermatol. 2017 Jan;62(1):7.

American Diabetes Association. Diabetes Care 2004 Jan;27(suppl 1):s11-s14.

American Diabetes Association. Diagnosis. Available at: Accessed February 2020.