Diabetic Skin Conditions and Skin Care Instructions

Diabetes is often believed to just cause problems with blood sugars, high blood pressure, heart disease and kidney disease.  Less serious, but no less problematic are diabetic skin conditions. Diabetes can affect the skin in many different ways and patients with worse control over their diabetes tend to have an increase in skin conditions.  Fortunately, most skin conditions in diabetes can be easily identified and treated fairly promptly so that the skin can be free of rashes, infections, and ulcerations so commonly seen in the disorder.

Several skin conditions can be directly related to either having diabetes mellitus in good control or having diabetes in poor control. Diabetes in good control can still lead to skin problems but, in fact, having good glucose control over diabetes can positively affect the quality of the skin and can reduce the incidence of the more severe and difficult-to-control skin problems of diabetes.

Bacterial Skin Infections in Diabetes

The immune system in diabetes is, by definition, poor.  Even good diabetic control doesn’t seem to completely restore the diabetic’s ability to fight off infections of the skin. Common bacterial skin infections seen in diabetes include the following:

• These are infections of the nail bed or of the skin of the base of the nails. Many of these are fungal but a few can be bacterial, usually from Staphylococcal infections or Streptococcal infections.
• These are deep skin infections of the tissue beneath the skin and usually represent a cluster of boils or infections of the hair follicles that have gotten deeper into the tissues.
• These are bacterial infections located at the base of the hair follicle.  Most are small and well localized to areas of the body with a lot of hair follicles.   They tend not to be extremely deep infections.
• These are small abscesses located just beneath the skin that are usually caused by Staphylococcal infections. They may originate as an infected hair follicle or an infected skin gland that goes deeper into the tissues.
• These are small bacterial infections that are caused by infections of the glands of the eyelids. They are usually caused by Staphylococcal infections of the gland.

These types of bacterial infections of the skin can be easily identified as being painful, swollen, hot, and reed.  As mentioned, Staphylococcus is the usual cause of diabetic skin infections but streptococcal organisms can also play a role.  These infections used to be extremely serious for diabetics but now, advances in surgical drainage and antibiotic use has reduced the intensity and spread of these infections. The best prevention for these kinds of infections is to keep the best cleanliness of the skin as possible.

Fungal Infections in Diabetes

Diabetics just don’t have the immune system to fight off common fungal and yeast infections, such as Candida albicans infections.  These are yeast organisms that tend to grow most in moist areas of the skin.  This means they can be found in sweaty armpits, under breast skin folds, in abdominal skin folds, and between wet and sweaty toes.  Nail folds can be affected by fungal infections, the corners of the mouth can be involved, and men can get fungal infections of the groin and the foreskin in men who aren’t circumcised.  Diabetics are especially able to catch common fungal infections, such as athlete’s foot, ringworm, jock itch, and vaginal yeast infections.

Pruritus

Pruritus basically means “itching” and this is a common symptom seen in diabetics.  Any type of fungal infection will be itchy in the diabetic, and the diabetic can have itching secondary to dry skin, bacterial infections, and poor circulation.  The lower legs are high-risk areas for itching in diabetes, both because of dry skin and small microvascular disease affecting the circulation to the skin.  Itching unfortunately, is more than just a nasty symptom.  Itching can break open the skin, leading to secondary wound infection or ulceration. The best way to improve itching is to bathe infrequently and use a good moisturizer on the skin after using mild soap and water to leans the skin.

Acanthosis Nigricans

This is a skin condition almost exclusively seen in type II diabetics.  Patients are usually extremely overweight and develop raised brown or tan skin lesions that grow on the side of the neck, the groin, the armpits, the hands, the knees, and the elbows.  The main treatment is to lose weight but keratolytic agents, such as topical tretinoin 0.05%, ammonium lactate 12% cream, or a combination of the 2) and triple-combination depigmenting cream (tretinoin 0.05%, hydroquinone 4%, fluocinolone acetonide 0.01%) can help decrease the thickening and darkened appearance of these lesions.

Diabetic Dermopathy

Diabetic dermopathy is exclusively seen in diabetics who are extremely prone to small vessel changes from atherosclerosis.  The lack of circulation causes scaly, light brown patches in the skin that may be circular or oval in shape.  They look like age spots but can be identified because they occur mainly on the front aspect of the legs.  They are painless and don’t itch. While they are unsightly, they don’t need to have any treatment; however, keratolytic therapy can reduce the look of these lesions.

Necrobiosis Lipoidica Diabeticorum

Another disorder that can be caused by alterations in the small blood vessels in diabetic patients is necrobiosis lipoidica diabeticorum or NLD.  This skin disease is much similar to the lesions seen in diabetic dermopathy but you won’t see as many lesions and they are larger than those seen in diabetic dermopathy.  They start as red, dull, and raised lesions that become shinier with a scarlet or violet border.  The skin can thin so the blood vessels can be seen beneath the lesion.  Itchiness and pain are common that can be so severe that the skin opens up.  Fortunately, this is a rare complication of diabetes and only needs treatment if the lesions become infected.

Skin Allergies in Diabetes

Diabetics are prone to skin reactions that are allergic responses to medications, such as those taken for diabetes or insulin. Skin reactions can be itchy and usually involve lesions that can deep and ulcerative.  If the allergy is to insulin, the reaction will be localized to the injection site.  Changes in medications and insulin types can help reduce chronic allergic reactions.

Blisters in Diabetes

In rare cases, diabetics can suffer from blisters on most parts of the body, including the fingers, hands, feet, toes, legs, and forearms. They look like second degree burn blisters but are not painful.  They can become very large and can get infected.  They usually heal without scarring in a few weeks as long as they are kept clean, kept from being infected, and if the blood sugars are lowered.

Tips to Prevent Skin problems in Diabetics

Like the other organs of the body that need extra care in diabetes, so does the diabetic’s skin.  Some tips that can help keep the diabetic’s skin intact and lesion-free include the following:

• Stay away from hot baths and use a moisturizing soap and a moisturizing lotion on dry skin areas.
• Keep the blood sugars in good control as the diabetic skin lesions are due to having high blood glucose levels.
• Maintain dry and clean skin.
• Prevent skin from becoming so dry that it becomes itchy.
• Treat any open wounds immediately and thoroughly.
• Use a humidifier during cool, dry seasons.
• Use a mild soap and shampoo in the shower.
• Check for any foot sores or areas of ulceration.

It should be noted that diabetics with diabetic neuropathy have this problem because of poor circulation to the nerves and poor nerve function.  These patients have double the problem.  They have poor circulation, which makes them prone to diabetic ulcers and diabetic skin conditions and have poor nerve supply, which makes the identification of painful sores and lesions very difficult.