Skin Deep: Diabetes and Skin Diseases

Skin problems are common in diabetics due to blood vessel damage and nerve conditions. The skin is the largest organ of the body, weighing approximately 25 pounds.[1] Diabetics have a tendency to develop dry skin and to develop skin changes due to changes in collagen fibers. There are also skin conditions that develop and the reasons are not known – like Acanthosis Nigricans.

Diabetes and Skin Disease

An estimated 33% of all those who have diabetes will develop one of the disorders of the skin that can be attributed to the disease. While it is true some people are more susceptible to skin conditions than others, individuals who have diabetes are more prone to develop skin conditions. For example, in the average population, the annual incidence of foot ulcers is 1.0% to 4.1%. Among diabetics it ranges from 4% to 10%.[2] Furthermore, certain skin disorders only occur when someone has diabetes. They include:

  • Necrobiosis lipoidica diabeticorum
  • Diabetic dermopathy
  • Eruptive  xanthomatosis
  • Diabetic blisters

Diabetics, like everyone else, are also capable of getting the same bacterial and fungal infections or itching sensations that are not related to the disease.

 

Bacterial Infections

Diabetics may fall prey to several different types of bacterial infections:

  • Styes
  • Infections of the hair follicles or folliculitis
  • Carbuncles
  • Boils
  • Infections of the nails

Usually, symptoms of bacterial infections include hot, red, swollen, and painful tissues. While several bacteria may be responsible, the most common is staph which is short for Staphylococcus bacteria. Medications and antiseptics can help treat this skin issue, but the best treatment is simply to take good care of the skin by keeping it clean and moisturized.

Fungal Infections

The major cause of fungal infections in diabetics is Candida albicans – yeast.[3] It crops up in the skin folds where moisture can be trapped and leads to prickly areas of red irritation within a region characterized by small eruptions and scales. Areas of concern include:

  • The breasts – beneath them
  • The nails
  • The fingers – between each digit
  • The toes – between each toe (athlete’s foot)
  • Mouth – the corners
  • The foreskin – in uncircumcised males
  • The armpits
  • Groin

Medication will help ease and cure any of these skin conditions.

Itching

Itching for a diabetic can be caused by one of several factors. These include:

  • A yeast infection
  • Dry skin
  • Poor circulation

These conditions can frequently be handled without resorting to a doctor’s care. You can reduce your time showering or the time spent in a bath which promotes moist skin. Your soap of choice should contain moisturizer and be mild. When you are finished bathing always rub on moisturizing skin cream.

Diabetes-Related Skin Conditions

In addition to the regular and more common disorders, there are specific diseases of the skin related to diabetes.[4]

·         Diabetic Dermopathy or microangiopathy – Dermopathy appears as pale brown, scaly oval or circular patches. They show up on the legs, generally at the front. They are easily mistaken for age spots. Dermopathy doesn’t need to be treated because it causes no harm.

·         Necrobiosis Lipoidica Diabeticorum (NLD) – NLD is a rare skin disorder more commonly occurring among adult women. Diabetic dermopathy and NLD look similar. The spots, however, are less in number, larger, and deeper. The spots progress in size and alter in consistency and color – from red to purple. They may be itchy and erupt. If this occurs, you will need to visit a doctor.

  • Atherosclerosis Related Skin Conditions – Atherosclerosis refers to a thickening of the arteries.[5] With the narrowing of the blood vessels come specific changes to the skin including a lack of hair and a pronounced sheen. If any damage occurs to the legs, they are slow to heal. As a result, if you even slightly damage the surface of your skin, a gaping sore can appear that is very slow to heal.

If an individual already suffers from neuropathy (a disease affecting the nerves), the tendencies for injuries to the foot are more likely increase. Lacking sensation means these injuries and ulcers can occur without the diabetic knowing unless the feet are checked regularly.  As a result, the wound is left untended and festers. With the addition of atherosclerosis and its decreased blood flow, the infection progresses.

  • Bullosis Diabeticorum (Diabetic Blisters) – This is a relatively common condition that tends to occur in those with diabetic neuropathy. When it occurs, probable locations include the backs of feet, fingers, hands and toes. Sizes vary. As they heal themselves and leave no scars, no medications are usually necessary. It is, however, essential to control blood glucose levels to prevent a return of these blisters.
  • Eruptive Xanthomatosis Solid, yellow, enlargements the size of peas and that have a red halo form on the skin. The usual locations are on the arms, buttocks, backs of hands, feet and legs. It is most common among young men with type 1 diabetes (T1D). Caused by out of control diabetes, it disappears when the disease is properly managed.
  • Digital Sclerosis – This is taut, thick, wax-like skin on the backs of hands, toes or foreheads. Stiffness of the joints of the fingers occur impeding normal movement. The occurrence rate of digital sclerosis is approximately one third among T1DM. The solution is to control blood glucose levels.
  • Disseminated Granuloma Annulare – Red, reddish-brown or flesh-colored rashes appear shaped like a raised ring- or an arc on the skin. Areas in which it is found are usually at a distance from the central trunk e.g. ears, fingers, although there are exceptions. Request medication from your doctor to treat this problem.
  • Acanthosis Nigricans – Common among extremely overweight individuals, this condition features raised brownish or tan areas along the armpits, groin and sides of the neck. Losing weight will decrease the problem.

When you have diabetes, it’s important to keep the skin moisturized or hydrated. The stress on the blood vessels caused by diabetes can result in exceptionally dry skin. Dry skin tends to crack and that creates the perfect environment for infection. However, some locations like between the toes and the armpits should be kept dry to prevent fungal growth.

References

[1] Garnero, T (2008). Your First Year With Diabetes. Alexandria, VA: ADA.

[2] Singh, N; Armstrong, DG; and Lipsky, BA (2005). “Preventing Foot Ulcers in Patients with Diabetes.” JAMA, 293(2): 217– 228.

[3] Levin, ME; and Pfeiffer, MA (editors) (2009). The Uncomplicated Guide to Diabetes Complications, 3rd ed. Alexandria, VA: ADA.

[4] Ragunatha, S;  Anitha, B; Inamadar, AC; Palit, A; and Devarmani, SS (2011). “Cutaneous Disordersi 500 Diabetic Patients attending Diabetic Clinic.” Indian J Dermatology, 56(2): 160–164.

[5] Marcovitch, H (2006). Black’s Medical Dictionary 41st edition. Lantham, Maryland: Scarecrow Press.

[6] This article was originally published July 12, 2012 and last revision and update of it was 9/10/2015.