If you have diabetes, it is important to be aware of the potentially serious skin problems associated with it and to see a doctor before the problem gets out of hand. In most cases, skin problems associated with diabetes can be managed through early diagnosis and treatment.
Skin problems associated with diabetes
- Diabetic scleroderma: Although rare, this skin problem can affect people with type 2 diabetes, causing thickening of the skin on the back of the neck and upper back. Treatment is to get the blood sugar under control. Lotions and moisturizers may help soften the skin.
- Vitiligo: Vitiligo is a skin problem that affects the color of the skin and is more common in people with type 1 diabetes than type 2 diabetes. With vitiligo, the special cells that produce pigment (the substance that controls skin color) suffer damage, causing the skin to fade in patches. Vitiligo usually involves the chest and abdomen, but may also appear on the face around the mouth, nostrils and eyes. Current treatment options for vitiligo include topical steroids and color tattooing (tattooing). If you have vitiligo, you should use a sunscreen with a sun protection factor of 30 or higher to prevent sunburn of the discolored skin.
Skin problems associated with diabetes and insulin resistance
- Echinoderma nigricans. This is a skin problem that can cause darkening and thickening of certain areas of the skin, especially in the skin folds. The affected skin turns brown or tan, sometimes slightly raised and velvety. In most cases, they look like small warts and appear on the side or back of the neck, in the armpits, under the breasts, and in the groin. Occasionally, the tops of the knuckles may develop an extremely unusual appearance. Acanthosis nigricans usually occurs in overweight people. Although there is no cure for acanthosis nigricans, weight loss can improve this skin condition. Acanthosis nigricans usually precedes diabetes and can be considered a sign of diabetes. There are other health conditions known to cause cutaneous acanthosis, including acromegaly and Cushing’s syndrome. This condition is thought to be a cutaneous manifestation of insulin resistance.
Dermal problems associated with reduced blood supply to the skin
- Skin problems associated with atherosclerosis: Atherosclerosis is a serious health condition caused by the thickening of blood vessel walls due to plaque buildup, which in turn causes narrowing of the blood vessels. Although atherosclerosis usually occurs in the blood vessels in or around the heart, it can also affect blood vessels throughout the body, including those that supply blood to the skin. When the blood vessels that supply blood to the skin narrow, changes can occur in the skin due to a lack of oxygen, such as hair loss, thinning and shiny skin (especially on the shins), thickened and discolored toenails, and cold skin. Because the blood carries white blood cells that help fight infection, legs and feet affected by atherosclerosis heal more slowly after an injury.
- Progressive diabetic lipid necrosis (NLD): Progressive diabetic lipid necrosis is thought to be caused by changes in subcutaneous collagen and lipid content. The affected areas of skin become thin and red. Most lesions appear on the lower part of the legs, and if traumatized, ulceration may occur. There is a fairly clear border between the lesion and the normal skin. Sometimes, NLD is itchy and painful. As long as the sore does not rupture, there is no need for treatment. If the wound ruptures, see a doctor and get treatment.
- Diabetic skin disease: Also known as shin spots, this skin condition is caused by changes in the blood vessels that supply blood to the skin. The skin condition presents as round or oval lesions with thin shiny skin on the lower front of the lower leg. These patchy lesions are not painful, although in rare cases they can cause itching or a burning sensation. Treatment is usually not necessary.
- Puffy sclerosis: Puffy sclerosis is a health condition in which the skin of the toes, fingers, and hands becomes thick, shiny, and taut. Finger joints may also become stiff. Treatment is to control blood sugar levels. Lotions and moisturizers may help soften the diseased skin.
- Rash xanthomatosis: This skin condition may occur when blood sugar levels are not well controlled and triglycerides rise to extremely high levels. Severe insulin resistance makes it difficult for the body to remove fat from the blood. With these extreme elevations in blood fats, there is a risk of developing pancreatitis (an inflammatory disease of the pancreas). On the skin, rash xanthomatosis looks like hard, yellow, shiny pea-like bumps. These bumps are surrounded by a red, itchy halo and are usually found on the face and buttocks. They can also be found on the backs of the arms and legs and in the folds of the extremities. Treatment for rash xanthomatosis involves controlling the level of fat in the blood. The rash will subside within a few weeks. Lipid-lowering medications may also be needed to control the different types of fat in the blood.
Rash, bumps, and blisters
- Rashes and bumps: Allergic reactions to food, bug bites, and medications may cause rashes, dimples, or bumps on the skin. For people with diabetes, it is especially important to check for skin problems such as rashes or bumps at the site of insulin injections.
- Diabetic blisters (diabetic macules): Rarely, people with diabetes can develop skin problems such as blisters that resemble burn blisters. These blisters may appear on the fingers, hands, toes, feet, legs, or forearms. Diabetic blisters are usually painless and heal on their own. These skin problems often occur in patients with severe diabetes and diabetic neuropathy. Getting blood sugar levels under control is the treatment for this problem.
- Disseminated granuloma annulare: This skin condition creates well-defined rings or curved areas on the skin. These rashes most often appear on the fingers and ears, but may also appear on the chest and abdomen. The rash may be red, reddish-brown, or skin-colored. Treatment is usually not needed, but sometimes topical steroid medications (such as hydrocortisone) may be helpful.
Diabetes mellitus and bacterial and fungal infections
- Bacterial infections: There are several different types of common bacterial infections of the skin in people with diabetes. Skin infections caused by bacteria called staphylococci are more common and more serious in people with diabetes who have poor blood sugar control. These bacteria may form “sores” (inflamed nodules that originate from hair follicles), which may appear in areas where hair follicles are irritated. Other infections include blepharitis (infection of the eyelid glands) and nail bacterial infections. Most bacterial infections require treatment with antibiotics (pills and/or creams).
- Fungal infections: In people with diabetes, a yeast-like fungus called Candida albicans is the cause of many fungal infections that cause skin problems. Women are particularly susceptible to this fungal infection in the vagina. Other common areas of infection include what is called “corns” in the corners of the mouth. When corns are present, they feel like small cuts in the corners of the mouth. The fungus can also be found between the toes and fingers and in the nails (onychomycosis). This fungus produces an itchy, bright red rash, usually surrounded by tiny blisters and scales. These infections usually occur in warm, moist folds of skin. Three common fungal infections are ringworm (red, itchy areas on the genitals and inner thighs), tinea pedis (affecting the skin between the toes), and ringworm (ring-shaped, scaly patches that may itch or blister and appear on the feet, groin, chest and abdomen, scalp, or nails). Fungicidal drugs are usually needed to treat these infections. In patients with diabetes, a rare but potentially fatal fungal infection of Trichophyton rubrum may occur. This infection usually starts in the nasal cavity and may spread to the eyes and brain.
Other causes of skin problems
- Itching: Itchy skin, also called pruritus, can have multiple causes, such as a yeast infection, dry skin, or poor blood flow. When itching is caused by poor blood flow, the lower extremities and feet are most often affected. Using a lotion helps keep the skin soft and moist, and may prevent itching caused by dry skin.
Can I prevent the skin problems associated with diabetes mentioned above?
Keeping your diabetes under control is the most important factor in preventing these skin problems. Follow your healthcare provider’s recommendations for nutrition, exercise, and medication to keep your blood sugar levels within the range recommended by your doctor. Proper skin care can also help reduce the risk of developing diabetes-related skin problems.