Diabetes can affect all body systems, but often the connection between diabetes and skin problems is missed. Up to one third of people with diabetes will experience skin problems related to the disease. If caught early, most conditions can be treated and resolved. Skin problems should be addressed and promptly treated to avoid serious consequences and complications.
Here is a summary of common skin problems that occur more frequently in people with diabetes, along with some skin problems that are specifically related to the disease.
If you have diabetes, and skin problems are a concern, the best way to prevent problems is to keep your diabetes in good control, keep blood sugar within recommended levels and practice good skin care.
General Skin Problems that Often Occur in People with DiabetesBacterial infections produce painful and swollen, inflamed skin that is often hot to the touch. These infections can usually be treated with antibiotics and improve with good blood sugar control. Bacteria can thrive in the presence of excess glucose. Examples of bacterial infections are boils, eyelid styes, carbuncles, nail infections and hair follicle infections. Staphylococcus is a common bacterium responsible for bacterial infections in people with diabetes.
Fungal infections produce itchy rashes in moist areas of the body, such as skin folds. These rashes can be red, surrounded by scales or blisters and have a yeasty white film in the folds of the skin. Prescription medicines and good diabetes control help in treatment. As with bacterial infections, excess glucose is beneficial to fungus. Examples of fungal infections are: yeast infections, jock itch, ringworm and athlete's foot. Candida albicans is a common fungus responsible for fungal infections in people with diabetes.
Dry Skin is more common in people with diabetes. Skin becomes flaky, sore and red. Eventually skin can crack, allowing germs to enter the body and cause infection.
Dry skin can be caused by high blood sugar levels because fluids are removed from the body via urination to help eliminate sugar. Nerve damage, which can be caused by diabetes, can also cause dry skin because the process of sweating is hindered by nerves that cannot properly receive or relay the messages to sweat.
Itching can be caused by dry skin, yeast infections and poor circulation. Poorly controlled diabetes can contribute to or cause dry skin and poor circulation. The lower legs are a common area to experience itching.
Diabetes-Specific Skin Problems
Acanthosis nigricans: Velvety dark patches of skin appear in skin folds, such as the neck, groin, armpits, knees, elbows and hands. This condition is related to insulin resistance and often appears before a diabetes diagnosis. Creams can help the appearance, but weight loss helps improve the condition and is the most effective form of treatment.
Allergic reactions: Reactions to diabetes medications can occur. Medications that can cause reactions include insulin, pills and some injectable medicines. Let your doctor know if you feel you are having a reaction to your medication.
Atherosclerosis: This is a thickening and hardening of the arteries that hinder circulation throughout the body, including blood supply to the skin. It can cause changes to the skin on the legs. The skin can become cool, thin, shiny and with little hair. Toenails can become thickened and discolored. This condition can cause slow healing of injuries in the lower extremities. Atherosclerosis can be prevented with diet, exercise, losing weight, quitting smoking and keeping blood pressure and LDL (bad) cholesterol levels in control.
Diabetic blisters (bullosis diabeticorum): This is a rare condition in which painless blisters develop on the extremities. They look like burn blisters and usually heal in about three weeks. This condition usually occurs in people with severely uncontrolled diabetes and neuropathy. The only known treatment is to improve blood sugar levels.
Diabetic dermopathy: Changes in small blood vessels that reduce blood supply to skin can cause oval or round patches that look similar to age spots. This condition is also called shin spots or skin spots. They are brown and scaly and most often appear on the front of the legs. This is a harmless, painless condition that does not need treatment.
Digital sclerosis: Skin on the hands, fingers and toes thickens and appears tight and waxy. Finger-joint stiffness may also be present. Digital sclerosis is more common in people with type 1 diabetes. Moisturizers may help, but treatment requires bringing blood sugar levels under control.
Disseminated granuloma annulare: This type of rash usually appears on the fingers and ears, and sometimes on the front of the torso. It presents as reddish or skin-colored arcs or ring shapes. Topical steroids can help, but usually this condition does not require treatment.
Eruptive xanthomatosis: Insulin resistance can contribute to very high triglyceride levels, which may produce itchy, waxy, yellow bumps on the skin. These bumps are pea-like and surrounded by red halos. They are most often found on the face and buttocks, and can also appear on the extremities. Treatment requires bringing blood fats under control; lipid-lowering drugs may also be needed.
Necrobiosis lipoidica diabeticorum: Changes in fat and collagen beneath the skin's surface cause the skin to appear thin and reddened. Spots are generally large, raised, red and appear on the lower legs. They develop into areas that look like a shiny scar with a violet border. These lesions can ulcerate and become itchy and painful. Treatment is necessary if the sores open. This condition is considered rare.
Scleredema diabeticorum: This is a rare condition that involves thickening of the skin on the upper back and neck. Moisturizers may help, but treatment entails bringing blood sugar levels within control.
Skin tags: About 25% of people with skin tags have diabetes. These are small, polyp-like pieces of flesh that occur most often on the neck, eyelids and armpits. There appears to be a link between skin tags and insulin resistance as well as to abnormal blood fats. There is no treatment necessary, and they can be removed if desired.
Diabetes in Skin Disease. The Electronic Textbook of Dermatology. Accessed: 12/20/2011 http://telemedicine.org/dm/dmupdate.htm
Skin Complications. American Diabetes Association. Accessed: December 18, 2011 http://www.diabetes.org/living-with-diabetes/complications/skin-complications.html
Van Hattem MD, Simone; Bootsma MD PhD, Aart H; Thio MD PhD, H Bing. Skin Manifestations in Diabetes. Cleveland Clinic Journal of Medicine 2008 75(11):772-787