Skin and Diabetes

We often tend to ignore problems relating to skin, but we must realise that skin is the largest organ in the human body. It covers your whole body and makes upto 16% of your overall body mass. It is approximately 2mm in thickness and also servers a whole lot of functions. It is vital in regulating your body temperature, it protects your body from environmental stressors like germs, pollution, variation from sunlight etc. It receives sensory information to touch, pain, temperature and vibration sensors. It stores water, fat and vitamin D. 

Now when you are talking about skin problems in diabetes, approximately 30% of diabetic patients will experience skin problems at some stage throughout the course of their illness. Long term Type II diabetes with uncontrolled blood sugars tend to be associated with poor circulation which reduces blood flow to skin. It can also cause damage to blood vessels and nerves. The ability of white blood cells to fight off infection is also decreased in the phase of elevated blood sugars. Decreased blood circulation can lead to changes in the skin’s collagen. This changes the skin’s texture, appearance and ability to heal. Damaged skin cells can even interfere with the ability to sweat. It can also increase the sensitivity to temperature and pressure. Diabetic neuropathy can cause a decreased sensation. This makes the skin more prone to wounds that may not be felt and therefore will be noticed only at a later stage.

What are the common types of skin infections seen in diabetic patients?

Diabetes can affect every part of the body, including the skin. In fact, some of the skin lesions seen are often the first indicators to know that the patient is diabetic. Diabetic patients are prone to a variety of bacterial and fungal skin infections. The commonest bacterial infections noticed in diabetic patients include styes which are infections of the glands of the eyelid, boils, folliculitis which are infections of the hair follicles, carbuncles which are deep infections in skin and the tissue underneath, nail infections, etc. The commonest fungal infection in diabetics is caused by the Candida Albicans species. These infections often occur in warm, moist forced skin especially under the breast in women, around the nails, between fingers and toes, corners of the mouth, under the foreskin of the penis, and in armpits and groin. Other common fungal infections include athlete’s foot, jock itch, vaginal infections etc.

There are various other skin problems which can happen mostly or only to people with diabetes. These include diabetic dermopathy, necrobiosis lipoidica diabeticorum, eruptive xanthomatosis, diabetic blisters, Digital sclerosis, shin spots, acanthosis nigricans, granuloma annulare, xanthelasma, skin tags, diabetic foot ulcers, and dry itchy skin etc. 

Now, to elaborate on a few important ones, diabetes can cause changes in small blood vessels. These changes can cause skin problems like diabetic dermopathy. These appear as light brown scaly patches which are oval or circular in shape, seen mostly in the front of both legs. It doesn’t hurt or itch and hence doesn’t need treatment. NLD or necrobiosis lipoidica diabeticorum also causes spots similar to diabetic dermopathy. But a few are larger and deeper. It starts as a dull red raised area which later becomes a shiny scar with a violet border. It is often itchy and painful too. Diabetic blisters can occur on the back of fingers, hands, toes, feet and sometimes on legs or forearms. They appear like burn blisters. They usually heal by themselves. Eruptive xanthomatosis appears as bumps and often look like pimples, seen usually on buttocks, thighs, elbows, back of knees, etc. they clear off suddenly once the blood sugar is under control. 

Shin spots are often brown spots on the shin and usually cause no symptoms. Unlike age spots, these spots are lines usually that start to fade off after few years. Acanthosis nigricans appear as dark patches or velvety skin on the back of your neck, armpit, groin etc. It means you have too much insulin in your blood. This is a sign of prediabetes. Digital sclerosis develops on the fingers or toes. It appears as tight waxy skin on the back of your hands. The fingers may become stiff and difficult to move. Xanthelasma are yellow scaly patches on and around your eyelids. These develop when you have high cholesterol levels in your blood. It can also be a sign of poorly controlled diabetes. If you have diabetes you are also likely to have dry itchy skin.

How do you prevent and manage skin infections in a diabetic patient?

Preventing the occurrence of a skin infection or injury is the key factor. Avoid and actively prevent dry skin by using moisturisers regularly. Avoid scratching dry skin which can create lesions and allow infections to set in. Treat cuts and wounds immediately with proper dressing and antibiotics if necessary. Avoid hot baths or showers as they can dry the skin out. Use talcum powder regularly to areas like armpits or back of knees where skin touches other parts of the skin. Avoid using moisturiser lotion between toes as this moisture can cause fungal infection between toes. Apply topical antifungals or oral antifungals to treat fungal infections if required. Take good care of your feet, check them every day for sores and cuts, wear broad flat shoes that fit well, follow a good healthy lifestyle with a healthy diet and maintain a good exercise schedule. Most important is to keep your blood sugar levels well under control. 

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