Diabetes: Skin Conditions

Many people with diabetes will have a skin disorder caused or affected by diabetes. Skin problems can be the first sign that a person has diabetes.

Diabetes can affect every part of the body, including the skin. Many people with diabetes will have a skin disorder caused or affected by diabetes at some time in their lives. In some cases, skin problems can be the first sign that a person has diabetes.

In some cases, people with diabetes develop skin conditions that can affect anyone. Examples of these conditions include bacterial infections, fungal infections, and itching. However, people with diabetes also are more prone to getting certain conditions. These include diabetic dermopathy, necrobiosis lipoidica diabeticorum, and eruptive xanthomatosis. Some common skin conditions in people with diabetes:

Acanthosis nigricans

This is a condition that results in the darkening and thickening of the skin. Often, areas of tan or brown skin, sometimes slightly raised, appear on the sides of the neck, the armpits, and groin. Occasionally, these darkened areas might appear on the hands, elbows, and knees. Acanthosis nigricans can affect otherwise healthy people, or it can be associated with certain medical conditions. It is frequently found in people with diabetes.

Allergic reactions

Allergic reactions to foods, bug bites, and medicines can cause rashes, depressions or bumps on the skin. If you think you might be having an allergic reaction to a medicine, contact your health care provider. Severe allergic reactions might require emergency treatment. It is especially important for people with diabetes to check for rashes or bumps in the areas where they inject their insulin.

Atherosclerosis

Atherosclerosis is the narrowing of blood vessels thickening of the vessel walls. While atherosclerosis most often is associated with blood vessels in or near the heart, it can affect blood vessels throughout the body, including those that supply the skin. When the blood vessels supplying the skin become narrow, changes occur due to a lack of oxygen. Loss of hair, thinning and shiny skin, thickened and discolored toenails, and cold skin are symptoms of atherosclerosis. Because blood carries the white blood cells that help fight infection, legs and feet affected by atherosclerosis heal slowly when they are injured.

Bacterial infections

There are different kinds of bacterial infections affecting the skin. These include styes, which are infections of the glands of the eyelids; boils, which are infections of the hair follicles; and carbuncles, which are deep infections of the skin and the underlying tissue. There also are bacterial infections that affect the nails. With a bacterial infection, the areas involved generally are hot, swollen, red, and painful. Most bacterial infections require treatment with antibiotics in the form of pills and/or creams.

Bullosis diabeticorum (diabetic blisters)

In rare cases, people with diabetes develop blisters that resemble burn blisters. These blisters—called bullosis diabeticorum—can occur on the fingers, hands, toes, feet, legs, or forearms. Diabetic blisters usually are painless and heal on their own. They often occur in people who have diabetic neuropathy.

Diabetic dermopathy

Diabetes can affect the small blood vessels of the body that supply the skin with blood. Changes to the blood vessels because of diabetes can cause a skin condition called diabetic dermopathy. Dermopathy appears as scaly patches that are light brown or red, often on the front of the legs. The patches do not hurt, blister, or itch, and treatment generally is not necessary. The patches are sometimes called skin spots.

Digital sclerosis

The word "digital" refers to your fingers and toes, and "sclerosis" means hardening. Digital sclerosis, therefore, is a condition in which the skin on your toes, fingers, and hands become thick, waxy, and tight. Stiffness of the finger joints also might occur. Lotions and moisturizers might help soften the skin.

Disseminated granuloma annulare

This condition causes sharply defined, ring- or arc-shaped areas on the skin. These rashes most often occur on the fingers, hands, and feet, but they can occur on the trunk. The rash can be red, red-brown, or skin colored. Treatment usually is not required, but some cases might benefit from a topical steroid medicine, such as hydrocortisone.

Eruptive xanthomatosis

Eruptive xanthomatosis can occur in some individuals when blood glucose levels are not well controlled and when triglycerides in the blood rise to extremely high levels. This condition appears as firm, yellow, pea-like bumps on the skin. The bumps—which are surrounded by red halos and can be itchy—usually are found on the feet, arms, legs, buttocks, and backs of the hands. Lipid-lowering drugs might be needed.

Fungal infections

A yeast-like fungus called Candida albicans is responsible for many of the fungal infections affecting people with diabetes. This fungus creates itchy red rashes, often surrounded by tiny blisters and scales. These infections most often occur in warm, moist folds of the skin. Treatment of fungal infections involves keeping the area dry and using a combination of topical steroid and antifungal medicines.

Itching

Itching skin, also called pruritus, can have many causes, such as a yeast infection, dry skin, or poor blood flow. When itching is caused by poor blood flow, the lower legs and feet are most often affected. Use lotions or creams, avoid taking hot showers, and use gentle soaps to help keep your skin soft and moist. Moisturizers will also prevent itching due to dry skin.

Necrobiosis lipoidica diabeticorum

Necrobiosis lipoidica diabeticorum (NLD) is caused by changes in the blood vessels and generally affects the lower legs. With NLD, the affected skin becomes raised, yellow, and waxy in appearance, often with a bluish-purple border. Sometimes, NLD is itchy and painful. As long as the sores do not break open, treatment is not necessary. See your health care provider for treatment if the sores do break open or if the lesions are painful.

Scleroderma diabeticorum

Like digital sclerosis, this condition causes a thickening of the skin; but scleroderma diabeticorum affects the skin on the back of the neck and upper back. This condition, which is rare, most often affects people with diabetes who are overweight. Lotions and moisturizers might help soften the skin.

Vitiligo

Vitiligo is a condition that affects skin coloration. With vitiligo, the cells that make pigment (the substance that controls skin color) are destroyed, resulting in patches of discolored skin. Vitiligo often affects the elbows, knees, and hands, but it might be found on the face (around the mouth, nostrils, and eyes). This condition can be seen in people with type 1 diabetes. You should use sunscreen with a SPF of 30 or higher to prevent sunburn on the discolored skin.

How can these skin problems be prevented?

Keeping your diabetes under control is the most important factor in preventing the skin-related complications of diabetes. Follow your health care provider’s advice regarding nutrition, exercise, and medicine. Maintaining control of blood glucose level within the range recommended by your health care provider is most important. Proper skin care also can help reduce your risk of skin-related problems.