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Diabetes-Related Skin Problems

Source: The Cleveland Clinic

For people with diabetes, having too much glucose (sugar) in their blood for a long time can cause some serious complications, including skin problems, as well as heart disease, stroke, kidney disease, eye damage and others.

How Can Diabetes Affect the Skin?

If your blood glucose is high, your body loses fluid, causing your skin to become dry. This occurs because the body is turning the water into urine to remove the excess sugar from the blood. Your skin also can get dry if the nerves, especially those in your legs and feet, do not get the message to sweat (because of diabetic neuropathy). Sweating helps keep your skin soft and moist.

In addition, dry skin can become red and sore, and can crack and peel. Germs can enter through the cracks in your skin and cause an infection. In addition, dry skin usually is itchy, and scratching can lead to breaks in the skin and infection.

Skin problems are common in people with diabetes. High levels of glucose in the blood provide an excellent breeding ground for bacteria and fungi, and can reduce the body's ability to heal itself. These factors put people with diabetes at greater risk for skin problems. In fact, as many as a third of people with diabetes will have a skin condition related to their disease at some time in their lives. Fortunately, most skin conditions can be prevented and successfully treated if caught early. But if not cared for properly, a minor skin condition can turn into a serious problem with potentially severe consequences.

What Are Some Common Skin Problems in People With Diabetes?

Some of the problems listed below -- such as bacterial infections, fungal infections, and itching --are skin conditions that can affect anyone. However, people with diabetes are more prone to getting these conditions, which can lead to serious complications. Some of the conditions listed - - such as diabetic dermopathy, necrobiosis lipoidica diabeticorum, and eruptive xanthomatosis --occur only in people with diabetes.

Some common skin problems in people with diabetes include:

* Acanthosis nigricans: This is a condition that results in the darkening and thickening of the skin. Often, areas of tan or brown skin, sometimes slightly raised, appear on the sides of the neck, the armpits, and groin. Occasionally, these darkened areas may appear on the hands, elbows, and knees. Acanthosis nigricans usually strikes people who are very overweight. There is no cure for acanthosis nigricans, but losing weight may improve the condition. Acanthosis nigricans usually precedes diabetes.

* Allergic reactions: Allergic reactions to foods, bug bites, and medicines can cause rashes, depressions, or bumps on the skin. If you think you are having an allergic reaction to a medicine, contact your doctor. Severe allergic reactions may require emergency treatment. It is especially important for people with diabetes to check for rashes or bumps in the areas where they inject their insulin.

* Atherosclerosis: Atherosclerosis is the narrowing of blood vessels from a thickening of the vessel walls. While atherosclerosis most often is associated with blood vessels in or near the heart, it can affect blood vessels throughout the body, including those that supply blood to the skin. When the blood vessels supplying the skin become narrow, changes occur to the skin due to a lack of oxygen. Loss of hair, thinning and shiny skin, thickened and discolored toenails, and cold skin are symptoms of atherosclerosis. Because blood carries the white blood cells that help fight infection, legs and feet affected by atherosclerosis heal slowly when they are injured.

* Bacterial infections: There are different kinds of bacterial infections affecting the skin. These include styes, which are infections of the glands of the eyelids; boils, which are infections of the hair follicles; and carbuncles, which are deep infections of the skin and the underlying tissue. There are also bacterial infections that affect the nails. With a bacterial infection, the areas involved generally are hot, swollen, red, and painful. Most bacterial infections require treatment with antibiotics in the form of pills and/or creams.

* Bullosis diabeticorum (diabetic blisters): In rare cases, people with diabetes develop blisters that resemble burn blisters. These blisters can occur on the fingers, hands, toes, feet, legs or forearms. Diabetic blisters usually are painless and heal on their own. They often occur in people who have diabetic neuropathy. Bringing your blood glucose level under control is the treatment for this condition.

* Diabetic dermopathy: Diabetes can affect the small blood vessels of the body that supply the skin with blood. Changes to the blood vessels because of diabetes can cause a skin condition called diabetic dermopathy. Dermopathy appears as scaly patches that are light brown or red, often on the front of the legs. The patches do not hurt, blister or itch, and treatment generally is not necessary. The patches are sometimes called skin spots.

* Digital sclerosis: Digital sclerosis is a condition in which the skin on your toes, fingers, and hands become thick, waxy, and tight. Stiffness of the finger joints also may occur. The treatment is to bring your blood glucose level under control. Lotions and moisturizers may help soften the skin.

* Disseminated granuloma annulare: This condition causes sharply defined, ring- or arc-shaped areas on the skin. These rashes most often occur on the fingers and ears, but they can occur on the chest and abdomen. The rash can be red, red-brown or skin colored. Treatment usually is not required, but some cases may benefit from a topical steroid medication, such as hydrocortisone.

* Eruptive xanthomatosis: Eruptive xanthomatosis can occur in some individuals not well controlled and when fats in the blood rise to extremely high levels. This condition appears as firm, yellow, pea-like bumps on the skin. The bumps -- which are surrounded by red halos and are itchy -- usually are found on the feet, arms, legs, buttocks, and backs of the hands. Treatment for eruptive xanthomatosis consists of controlling your blood glucose level. Drugs that control different types of fats in the blood (lipid-lowering drugs) may also be needed.

* Fungal infections: A yeast-like fungus called Candida albicans is responsible for many of the fungal infections affecting people with diabetes. This fungus creates itchy red rashes, often surrounded by tiny blisters and scales. These infections most often occur in warm, moist folds of the skin. Three common fungal infections are jock itch, which appears as a red, itchy area on the genitals and the inside of the thighs; athlete's foot, which affects the skin between the toes; and ringworm, which causes ring-shaped, scaly patches that can itch or blister. Ringworm can appear on the feet, groin, chest and abdomen, scalp or nails. Medicines that kill the fungus may be needed to treat these infections.

* Itching: Itching skin, also called pruritus, can have many causes, such as a yeast infection, dry skin or poor blood flow. When itching is caused by poor blood flow, the lower legs and feet are most often affected. Using lotion can help to keep your skin soft and moist, and prevent itching due to dry skin.

* Necrobiosis lipoidica diabeticorum: Necrobiosis lipoidica diabeticorum (NLD) is caused by changes in the blood vessels and generally affects the lower legs. With NLD, the affected skin becomes raised, yellow and waxy in appearance, often with a purple border. Sometimes, NLD is itchy and painful. As long as the sores do not break open, treatment is not necessary. If the sores do break open, see your doctor for treatment.

* Scleroderma diabeticorum: Like digital sclerosis, this condition causes a thickening of the skin; but scleroderma diabeticorum affects the skin on the back of the neck and upper back. This condition, which is rare, most often affects people with diabetes who are overweight. The treatment is to bring your blood glucose level under control. Lotions and moisturizers may help soften the skin.

* Vitiligo: Vitiligo is a condition that affects skin coloration. With vitiligo, the special cells that make pigment (the substance that controls skin color) are
destroyed, resulting in patches of discolored skin. Vitiligo often affects the chest and abdomen, but may be found on the face around the mouth, nostrils and eyes. This condition usually occurs in people with Type 1 Diabetes. There is no specific treatment for vitiligo. You should use sunscreen with a SPF of 15 or higher to prevent sunburn on the discolored skin.

Can These Skin Problems Be Prevented?

Keeping your diabetes under control is the most important factor in preventing the skin-related complications of diabetes. Follow your healthcare provider's advice regarding nutrition, exercise, and medication. Keep your blood glucose level within the range recommended by your doctor.


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