Diabetes and Skin

Diabetes and Skin

It is estimated that 30% of patients with diabetes mellitus will experience a skin problem at some stage through the course of their disease. When diabetes affects the skin, it is often a sign that your blood sugar levels are too high. This could mean that:

• You have undiagnosed diabetes, or pre-diabetes.
• Your treatment for diabetes needs to be reassessed and adjusted.

The following are warning signs on the skin, which could indicate that you could be suffering from diabetes or your diabetes is not under desired control.

• Acanthosis Nigricans – Darker area of skin that feels like velvet on the back of your neck, armpit, groin, or elsewhere could mean that you have too much insulin in your blood. This is often a sign of prediabetes.
• Skin Tags – These harmless growths are most common on the eyelids, neck, armpit and groin. The presence of numerous skin tags may be a sign that you have type 2 diabetes.
• Extremely, Dry Itchy Skin (Xerosis) – If you have diabetes, you are more likely to have dry skin. If you have a skin infection or poor circulation (also encountered in people with diabetes), these could also contribute to dry, itchy skin.
• Skin InfectionsPeople who have diabetes tend to get recurrent bacterial, fungal and yeast skin infections.

  If you have a bacterial skin infection, you will notice one or more of the following:

  Hot, swollen skin that is painful (boils – folliculitis, furunculosis, carbuncle), red swollen and diffuse over the legs (cellulitis).

  An itchy rash and sometimes tiny blisters on dry scaly skin (infected eczema).

  An itchy/painful sometimes reddish rash between your toes (intertrigo), swelling with pain around one or more of your nails (paronychia), and on your scalp.

  Fungal and yeast (Candida) infections are common in people with diabetes.

  Extensive ringworm-like lesions, nail fungal infections are seen frequently.

  Genital infections (balanoposthitis/vulvovaginitis) are commonly encountered in diabetics and frequently serve as an important clinical pointer to an underlying undiagnosed/poorly controlled diabetes in an individual.

• Open Sores and Wounds (Diabetic Foot Ulcers)Poor circulation and nerve damage due to longstanding diabetes can make it hard for your body to heal wounds. This is especially true on the feet. Secondary bacterial infection can complicate these ulcers.

  If you have a non-healing wound especially on the feet, you should seek a physician’s help to rule out diabetes.

• Diabetic Dermopathy – Brownish black asymptomatic spots commonly seen on the shin. Unlike age spots, these spots and lines usually start to fade after 18 to 24 months.
• An outbreak of small, reddish-yellow raised pimple-like eruptions over buttocks, thighs, elbows, or backs of the knees (eruptive xanthomas), yellowish scaly patches on and around your eyelids (xanthelasma) – indicative of hyperlipidemic state very frequently occurring in diabetics (especially poorly controlled).
• Blisters (Diabetic Bullae) – It is rare, but people with diabetes can see painless blisters suddenly appear on their hands, feet, legs or forearms.
• Yellow, Reddish, or Brown Patches (Necrobiosis Lipoidica) – Patches of swollen, hard yellow, reddish, or brown skin sometimes itchy and painful going through cycles where it is active, inactive, and then active again.
• Diabetic Stiff Skin – Many patients with longstanding type 1 diabetes develop diabetic cheiroarthropathy or diabetic stiff skin (digital sclerosis). This results in restricted mobility of the joints of their hands and stiff, waxy and thickened skin.

Other dermatological diseases which can be associated with diabetes include psoriasis, lichen planus, vitiligo, generalized granuloma annulare and hidradenitis suppurativa. All these conditions are diagnosed and managed by dermatologists with the diabetic control part managed by the patient’s physician.

Diabetic Medication-Related Dermatological Conditions

Insulin – Soft swelling at injection sites (lipohypertrophy). With avoidance of subcutaneous insulin at affected sites, lipohypertrophy normally improves over the course of a few months.

Round concave depressed areas (lipoatrophy). This used to occur more frequently prior to the introduction of modern purified forms of insulin.

Allergic reactions to subcutaneous insulin are rare, with systemic allergic reactions occurring in only 0.01% of patients.

Oral Hypoglycemic Agents – Oral hypoglycemic agents may cause a number of different cutaneous adverse effects such as erythema multiforme or urticaria.

DPP 4 Inhibitors (Gliptins) – May be associated with inflamed blistering skin lesions, including bullous pemphigoid and Stevens-Johnson syndrome, as well as angioedema.

SGLT2 Inhibitors (Flozins) – An increased risk of genital fungal infections.

If you are on insulin or an oral hypoglycemic agent and develop skin rashes/skin textural changes, please contact a dermatologist or your treating physician immediately.

Skin Care for Diabetics

There are several things you can do to prevent skin problems:

• Work with your physician to better control your diabetes.
• Keep skin clean.
• Avoid very hot baths and showers. If your skin is dry, don’t use bubble baths. Moisturizing soaps may help. Afterward, use a fragrance-free moisturizing cream or lotion to prevent extreme dryness and cracking of the skin, especially in cold or windy weather.
• If you have diabetes, you should check your feet every day for sores and open wounds. Check them every day for sores and cuts. Wear broad, flat shoes that fit well. Check your shoes for foreign objects before putting them on.
• Treat cuts right away. Wash minor cuts with soap and water. Only use an antibiotic cream or ointment if your doctor says it’s okay. Cover minor cuts with sterile gauze. Consult your physician or dermatologist right away if you get a major cut, burn, redness or swelling over the legs/arms or any area of the body.
• See a dermatologist if skin problems are persistent or discomforting.

In conclusion, although each dermatological condition associated with diabetes may respond well to a variety of specific treatments, good glycemic control and lifestyle changes go a long way towards improving the response to treatment, thereby improving the dermatological as well as the overall quality of life of people with diabetes.