Diabetes is a common chronic disease. With the improvement of people’s living standards, population aging and the incidence of obesity increased, the incidence of diabetes is rising year by year, and the proportion of diabetics with skin disease has been reported to be up to 20 – 30%, some experienced doctors, according to certain skin manifestations, and further examination is found to be related to diabetes, some skin diseases into the early signals of diabetes, let us take a look at the diabetes-related Skin changes: 1, skin infections: skin infections are very common in diabetic patients, and even many patients are found to have diabetes when looking at skin infections. The occurrence of skin infections is very complex factors, the mechanism is not clear, it is believed that the patient’s blood glucose is elevated, the glycogen content of the skin tissue is also increased, which creates a good environment for mold and bacterial infections. It is also believed that diabetic patients are more prone to skin infections and their body tissues to maintain a high concentration of glucose and metabolites for a long time, so that the body’s immunity is reduced, the number of leukocytes is reduced, chemotaxis and phagocytosis of pathogens weakened ability related. There are thought to be parasitic in the body surface flora dysbiosis related to The types of pathogens that cause skin infections include bacteria, fungi, viruses and so on. It has been shown that more than 30% of diabetic patients are diagnosed due to purulent skin disease caused by bacterial infection. In addition, Staphylococcus aureus is significantly more likely to be isolated from the nasal vestibule of active diabetic patients than from non-diabetic or controlled diabetic patients. Infected patients develop boils, carbuncles, granulomas, multiple and persistent folliculitis on the skin, and in more severe cases, coccidioidomycosis, erysipelas, cellulitis, sepsis, etc., due to bacterial penetration into the deeper tissues of the skin, which is difficult to cure if diabetes mellitus is not well treated, and can be dangerous, even life-threatening, if secondary infection occurs in the area of inflammation of blood vessels in the extremities or damage to the nerves. It can even be life-threatening. It is better to do bacterial culture and drug sensitivity test, and choose highly sensitive drugs for treatment. Fungal infections: People with diabetes often develop “thrush” in the mouth. Thrush is caused by a mold infection called Candida. Candida infections can also occur on the fingernails, the glans in men, and the vagina and vulva in women. Ringworm on the skin is also caused by mold infections. Diabetic patients are prone to ringworm such as tinea cruris, tinea corporis, tinea cruris and tinea pedis. Treatment can be a combination of topical and internal antifungal medications depending on the condition. Viral infections: herpes simplex and herpes zoster can be seen, and warts are also seen. The treatment is symptomatic. 2, itchy skin: itchy skin is often one of the symptoms of diabetes mellitus, can be generalized itching, or limited itching, the latter especially in the vulva area, armpit. In 504 cases of diabetes mellitus, the incidence of pruritus was second only to fungal skin infections, accounting for 37.7%. Itchy skin most often occurs in the patient’s lower back and lower limbs, often manifested as persistent itching and dry skin, sometimes in conjunction with winter itch, due to scratching caused by the skin scratches, scabs and flaking, etc., and in severe cases, can also be in the scratched parts of the skin infection. Therefore, doctors often ask patients who suffer from itchy skin but the cause is not clear to do blood and urine routine and liver and kidney function tests to help find the cause. If it is clear that the itchy skin is caused by diabetes, the key to treatment lies in controlling the primary disease, and the itchy skin symptoms will usually be relieved when the diabetes is well controlled. In addition, because patients often appear dry skin, need to reduce the number of baths, less use of soap, bath, bath with emollient skin care products such as compound glycerin itching milk, glycerin water, etc., and at the same time in the itching of the local topical use of emollient anti-itching effect of the cream to alleviate the symptoms, if necessary, can be taken before going to bed with a number of sedative effect of the classic antihistamines (such as Antares, Parnate, etc.) to alleviate itching It is also important to take some classic antihistamines with a sedative effect (e.g., Advil, Paracetamol, etc.) before going to bed to reduce itching and promote sleep. Suffer from itchy skin, especially need to pay attention to as far as possible to do not scratch the affected area, do not use concentrated salt water, pepper water, chili water, hot water and other hot water to wash the affected area to stop itching, otherwise it will aggravate the inflammation of the skin and cause more intense itching, but also may cause damage to the skin to cause secondary bacterial infections. 3, diabetic dermatosis: 1) skin flushing: the face of patients with the disease can appear special rose-colored flushing spots, when the condition is serious, the palm and plantar areas can also appear in the above rashes, which is due to diabetic patients with reduced elasticity of the skin capillaries and abnormal expansion caused by. It has also been found that 80% of patients with mild or occult diabetes may have varying degrees of flushing. Generally, there are no conscious symptoms, and most of them do not attract attention. (2) Abnormal pigmentation : Round atrophic patches appear on the skin in front of the shins, thighs or other parts of the body, dark brown in color, with a large number of scales on the surface. At first, the lesions are round or ovoid dark red papules, which then become dark brown, and after years of persistence, they form hyperpigmented patches or atrophic scars, with new lesions appearing around them continuously. The disease is more common in men than in women. According to the domestic statistics of 304 cases of diabetes mellitus, pretibial pigmented spots account for the 1st place in skin lesions, amounting to 14.4%, and about 15%~50% of diabetic patients occur in this disease in foreign statistics. Modern medicine is believed to be in the diabetic microangiopathy caused by chronic skin nutritional disorders on the basis of repair reactions caused by minor trauma. Diabetic patients with lower limb circulatory disorders than the upper limb is obvious, and vulnerable to trauma, so the lesions are mostly seen in the tibial front. Early and aggressive treatment of diabetes can control the progression of skin lesions. Localized symptomatic treatment is available. (3) Hesperidosis: this is diabetic metabolic orange peel, carotenemia. More than half of diabetic patients have orange peel pigment, carotenemia, and orange peel pigment, carotenoid deposits can make the palmoplantar and facial skin yellow, while the sclera is not yellow stained. Reduce the intake of oranges, tangerines, carrots, and pumpkin in food, and the skin pigmentation can slowly subside. 4) Diabetic maculopapular: characteristic but rare. Diabetic patients in the absence of obvious triggers and aura symptoms blisters occur suddenly, their hands and feet can appear scald-like blisters or blisters. The blisters may be single or multiple, with thin walls, clear pulp, and no inflammatory redness around them. The diameter of the blisters ranges from a few millimeters to several centimeters. The patients often have no obvious self-conscious symptoms, the onset of about 2 – 3 weeks after the blister or blister, can be dry and crust, after healing does not leave scars. Try to extract the blister under sterile conditions, keep the blister wall intact, and apply pressure bandage to prevent infection. (5) Diabetic lipoid progressive necrosis: 1/3~1/4 of patients with lipoid progressive necrosis of the skin suffer from diabetes mellitus, which is more common in female patients. Therefore, once the disease is diagnosed, regular laboratory tests are needed to check whether diabetes mellitus is present. The relationship between progressive necrobiosis lipoidica and diabetes mellitus is unclear and can occur before, during, or after diabetes mellitus, but the severity of the skin lesions or the presence or absence of morbidity is not related to the course or severity of diabetes mellitus. The disease occurs preferably on the anterior and lateral skin of the lower legs, but can also occur on the upper extremities and trunk. The lesions tend to appear as dark red patches that are well demarcated from normal skin. These lesions are usually painless and itchy, and only feel painful after a breakout occurs. If it occurs on the scalp, it can cause scalp atrophy and baldness. Modern medicine believes that the occurrence of this disease is related to diabetic microangiopathy. Due to the deposition of glycoprotein in the wall of small blood vessels, gradually causing vascular occlusion, tissue ischemia, resulting in collagen degeneration and necrosis and the onset of the disease. Direct immunofluorescence has been used to find IgM, IgA, C3 and fibrinogen deposits in the walls of small blood vessels in the infested lesions, which suggests that the pathogenesis of this disease may be an immune-complex vasculitis. The treatment of this disease, as with other dermatologic conditions complicated by diabetes mellitus, lies primarily in the detection and treatment of diabetes mellitus. However, the various treatments for diabetes do not help much with skin damage, and there is a particular need to protect the skin against breakouts. Once stubborn ulcers and necrosis form surgical excision of necrotic tissue and skin grafting can be considered. (6) Diabetic xanthoma: often occurring rapidly in groups, the disease is common in the patient’s face (especially around the eyelids), but also can be seen in the patient’s trunk, limbs, buttocks and other places. It is a symmetrical yellow nodule or plaque of about 0.5 centimeters, surrounded by mild flushing, and itchy. About 0.1% of diabetic patients can develop this disease due to abnormal lipid metabolism. Treatment is as soon as possible to control blood sugar and treatment of lipid metabolism abnormalities. 4, diabetic skin vasculopathy: diabetic skin microangiopathy, can be seen in any part of the body, mainly violates the small arteries, capillaries and small veins. Small blood vessels show endothelial cell proliferation, basement membrane thickening, but to the lower limb tibial front and foot skin microvascular involvement produces local cyanosis and skin ischemic ulcers are common. These ulcers are superficial, painful, and progressively worse. Sclerosis can also occur in other parts of the blood vessels, such as retinopathy, myocardial infarction, cerebral thrombosis, and renal arteriosclerosis. Finally, it involves the large blood vessels of the lower limbs, which are similar to arteriosclerosis occlusive disease. Even the formation of toe deformity and foot penetrating ulcers – diabetic ulcers and gangrene. The cure will be very difficult, and some of them have to practice amputation. 5, diabetic sclerosing edema, this is in the dermis between the collagen fibers have acidic mucopolysaccharides, especially hyaluronidase deposition of a mucin deposition disease. About 5% of diabetic patients with this disease, mostly in adults and obese patients; mainly in the neck, upper back and shoulders, the skin is light red or pale, the surface has a glossy non-sunken hard swelling, tissue thickening. There is no effective treatment. People with diabetes must pay attention to the changes that occur in the skin, early detection, early treatment, early prevention. Starting from the following aspects: 1. Pay attention to hygiene: In summer, it is hot and humid, which is the peak season for the growth and reproduction of germs, and diabetic patients are prone to skin infections, the most common of which are folliculitis, boils, carbuncles, dengue and ringworm, which are caused by bacterial, fungal and other pathogens. Therefore, paying attention to personal hygiene is very important, and it is necessary to keep the skin clean, change clothes and pants diligently, and keep the skin clean, and keep the skin cool and dry. Preventing skin trauma: The skin is in direct contact with the external environment, and in summer, when people are least clothed and their limbs are exposed, it is easy to cause various kinds of trauma, including scratching to relieve itchiness. The general public may not care about small trauma, but once diabetic patients have trauma, it will open the door for bacteria to enter, and even repeated episodes of infection. Therefore, prevention is the key, try to avoid all kinds of injuries. Diabetic patients with local trauma should be disinfected in a timely manner, pay attention to protect the wound, under the guidance of the doctor to actively treat, in order to prevent a small disease into a big disaster. 3, regulate diet: although skin lesions on the diet does not have special requirements, but diabetic patients if you do not pay attention to dietary control, it is easy to cause elevated blood glucose, causing skin lesions or affect the healing of existing skin lesions. 4, enhance immunity: most diabetic patients have decreased immune function, easy to cause germs infection, so improve immunity is also the focus of the prevention of skin damage. You can start from diet, exercise and other aspects to improve the body’s ability to fight diseases. 5, found special skin changes in time to the hospital. 6, control blood sugar.