Diabetic Skin Conditions
Diabetes can create a skin disorder. Everyone knows about the major long and short term complications of diabetes. But, when I first got my insulin pump, I discovered what many of my patients were aware of, and that is that skin conditions come with having diabetes. I can remember saying to the trainer that I could not have a fungal infection because my hemoglobin A1c was 6%. A specific over the counter anti-fungal ointment stopped the fungal infection process, and now I travel with this small tube just in case. I use it in the summer when I’m in the water and I develop itchy skin on my upper shoulder always in the same place. It’s gone and I’m happy. That was the first condition I lived through: there are others that people in my groups have shared. Once we began to talk about skin disorders, it’s amazing how relieved the members become as they talked about things that had worried them, but they were not sure what to do or who to talk to about them. As we talk about these conditions, we begin the discussion with the same caveats that we use for discussions about other complications of diabetes.
First, we want you to know that people who do not have diabetes get these conditions also, but as with many other complications, diabetics tend to get them more often. About a third of people with diabetes will have a skin disorder caused or affected by diabetes at some time. In fact, doctors report noting the presence of skin disorders before they diagnose diabetes. Second, in the space we have here, we will be outlining the major varieties of skin conditions. If you think you have one that needs treatment, please see your physician right away. Don’t wait. Finally, we end this article with some easy ways to protect your skin.
We have gathered this information from three of our favorite experts on diabetes, which includes the ADA, Cleveland Clinic Foundation and the AMA. All three organizations have a great deal of information for you. For years we have asked you to support organizations that promote research and care for diabetes, and these three are winners. We begin with three conditions that we all know about, and can pronounce.
Bacterial Infections: People with diabetes appear to suffer more bacterial infections than the general population. There are several kinds of infections that can affect those of us with diabetes. One is a sty, which is an infection of the glands of the eyelids. A second type is a boil, which are infections of the hair follicles. Carbuncles are deep infections of the skin and the tissue underneath. Infections can also occur around the nails. We all know bacterial infections. The infected tissue feels hot, and is usually swollen, red, and painful. The most common cause of bacterial infections is staph (Staphylococcus). We can all remember grandparents talking about how dangerous these infections were when they were children, but now they can be treated with antibiotics, either a cream or pill prescribed by your physician.
Fungal Infections: Canidida albicans, a yeast-like fungus, is responsible for many of the bothersome fungal infections that people with diabetes get. It causes itchy rashes and red areas on the skin with tiny blisters and scales. Yeast infections occur in warm moist folds of the skin. Some common infections are jock itch, athlete’s foot, and ring worm. All of these need to be treated by medication. See your physician.
Itching: Itching can be caused by a yeast infection, dry skin, or poor blood flow. When caused by poor circulation, it is prevalent in the legs. Using skin lotions can help your skin to remain soft and prevent this type of itching. Ask your health care team for the names of lotions they know will work.
Allergic reactions: You can have an allergic reaction to some medications, even to your insulin or anti-hyperglycemic pills, as well to insect bites, and food. As someone who has an allergic reaction to bee and wasp bites, I know how quickly I need medication. Do see your physicians if you think you are having an allergic reaction to something in your environment.
Atherosclerosis: We have shared many times that we as diabetics share a high risk for developing thickening of the arteries or atherosclerosis. We all have read how this affects the vessels that cause cardiovascular disease, but it can also affect vessels that supply blood to the skin. As this occurs, the skin changes and becomes hairless, thin and shiny. Your toes may feel cold and toenails thicken. Your calves may be painful during exercise because less oxygen is available. Because blood carries white blood cells which fight infection, legs and feet affected will heal slowly. People with neuropathy are most likely to have foot injuries because these people do not feel pain, cold, heat, or pressure. The wound can then go untreated and infections can develop. The reduction of blood flow can cause the infection to become severe. Do see your physician for this one.
Diabetic blisters (bullosis diabeticorum): These blisters are rare and resemble burn blisters. They usually appear on the fingers, hands, toes, feet, or forearms. They tend to be painless and heal on their own. They will heal faster if you get your blood glucose levels in the normal range. They are thought to be caused by diabetic neuropathy.
Diabetic Dermopathy: This is caused by changes in small blood vessels, and looks like light brown, scaly patches. It is often seen on the front of the legs and may be mistaken for age spots. They are harmless and don’t need treatment.
Digital sclerosis is another condition that can be treated by getting blood glucose levels back to a normal levels and keeping it there. It makes the skin on toes, fingers and hands thicken and become waxy and tight. You fingers may become stiff. It is rarer for this stiffness to affect knees, ankles or elbows.
Disseminated Granuloma Annulare: This is a mouthful of a skin condition which usually does not need treatment but can become serious enough to warrant a trip to your physician and steroid medication to clear up the sharply defined ring-shaped or arc-shaped raised area on the skin. It appears on fingers and ears and more rarely on the trunk. The rash is usually red, red-brown or skin colored.
Eruptive Xanthomatosis: This is another diagnosis that means strict control of blood glucose levels is needed as well as lipid-lowering medications at times. It consists of firm yellow pea-like enlargements in the skin. Each bump has a red halo and may itch. It occurs most often on the back of hand, feet, arms, legs and rear end.
Necrobiosis Lipoidica Diabeticorum: This is another disease caused by changes in the blood vessels and is similar to diabetic dermopathy. The difference is that the spots are fewer, but larger and deeper. It generally affects the lower legs. The skin becomes raised, yellow and waxy in appearance often with a purple border. It is a rare condition and, as long as the scores do not open, it does not need treatment. If, however, they do break open, see your physician.
Scleroderma Diabeticorum: This is a rare condition which, like digital sclerosis, causes thickening of the skin, but it affects the skin on the back of the neck and upper back. It is treated by bring blood glucose levels under control. The use of lotions may help keep the skin soft.
Vitiligo: This condition affects the coloration of skin. The cells that make pigment are destroyed, resulting in patches of discolored skin. There is no specific treatment for this condition, but using a sun screen is suggested.
There are ways to control skin conditions that we share readily with you. Keep your diabetes under control. As you read about these conditions you could not but notice how important that is. High blood glucose levels tend to cause dry skin and less of an ability to fend off bacteria. Infection can follow.
* Avoid very hot baths and showers. Use moisturizing soaps if your skin is dry. Use a lotion that your physician suggests after bathing. Keep the skin between toes dry-no lotions there.
* Prevent dry skin. Use lotions especially in the winter.
* Treat minor cuts and scrapes immediately. Use soap and water only. Nothing else as it is too harsh. See your doctor right away for a major cut, infection, or burn.
* Use unscented soaps and mild shampoos.
* In winter months use a humidifier when the heat is on.
* Take care of your feet. See our article on the subject so that you know how to do this. If you can, visit a podiatrist on a regular basis.
* Keep the name of a dermatologist in your telephone book just in case you can not cure your skin condition.
* Drink lots of fluids, such as water, to keep your skin moist and healthy.
* Wear all cotton underwear. It allows air to circulate
* Examine your body after washing to see if you have any of the skin conditions we listed. Let’s keep infections at bay.