Protecting the skin you're in: managing diabetes-related skin conditions

BY MARY GREEN

Diabetes can affect every part of the body, including your skin. In fact, according to the American Diabetes Association, about one-third of people with type 2 diabetes will develop a skin problem caused or affected by diabetes at some point in their lives. The statistics aren’t surprising considering that people with diabetes often suffer from nerve damage (diabetic neuropathy) that can lead to numb, injuryprone hands and feet, while poor circulation and high blood sugar slows down healing.

There are some conditions that most anyone can have, such as bacterial and fungal infections and itching. However, people with diabetes are more prone to these and others including diabetic blisters, diabetic dermopathy [der-mop’ă-thē], small, round, brown atrophic skin lesions that occur on the shins of patients with diabetes, and eruptive xanthomatosis [zan’thō-mă-tō’sis], firm, yellow, pea-like skin growths.

Most of these skin conditions can be treated with due diligence and a simple daily skin care routine, while others need treatment right away to prevent serious problems.

Below is more detail on how diabetes affects the skin, common conditions and pointers to protect the skin you’re in.

The Basics

If you have diabetes, there are several basic steps you can take to prevent skin problems:

  • Keep your diabetes well managed. When blood sugar levels run high, it causes the body to lose fluids and the skin to become dry, causing skin that may crack, itch and lead to infections. Moisturize your skin to prevent cracking and chapping, especially in windy or cold weather. Neuropathy can also lead to dry skin, as the nerves in the legs and the feet may not get the message to sweat, which is necessary to keep the skin soft and moist. So, the main message is moisturize, moisturize, moisturize.
  • Avoid hot baths and showers. If your skin is dry, don’t use bubble baths, as many of the ingredients can cause more dryness and irritation to the skin. Moisturizing soaps help.
  • Pat your skin dry after bathing—while rubbing the skin helps slough off dead skin cells, it can also aggravate the skin, reduce moisture and cause breaks, which leaves you more susceptible to infection.
  • Don’t put lotions between toes. The extra moisture there can encourage fungus to grow.
  • Treat cuts right away. Wash minor cuts with soap and water and cover with a sterile gauze secured with a hypoallergenic or paper tape. Only use an antibiotic cream or ointment if your doctor says it’s okay. Change the bandage at least once a day. See a doctor right away if you get a major cut, burn, or infection.
  • Avoid using feminine hygiene sprays or vaginal douches. They can alter the pH balance of the vagina and set the stage for increased fungal growth.
  • Drink plenty of fluids, like water and caffeine-free, sugar-free drinks, to keep your skin hydrated.
  • Eat foods rich in omega-3 fatty acids, which nourish the skin. This includes fish like salmon, sardines, albacore tuna and mackerel, as well as tofu and other forms of soybeans, walnuts, flaxseed and their oils.
  • Take extra good care of your feet. Check them every day for sores and cuts. Wear broad, flat shoes that fit well. Check your shoes for foreign objects before putting them on.
  • See a dermatologist (skin doctor) or consult with your endocrinologist about skin problems if you are not able to solve them yourself.

Bacterial Infections

Because bacteria feed on glucose (blood sugar), people with diabetes whose blood glucose isn’t in control have a higher risk of bacterial infection. That’s why even a tiny cut can become a major infection. Common bacterial infections that occur in people with diabetes include styes, (infections of the glands in the eyelid), boils folliculitis (infections of the hair follicles), carbuncles (deep infections of the skin and the tissue underneath) and infections around the nails. Infected tissue is usually hot, swollen, red and painful. Several different organisms can cause infections, the most common being staphylococcus bacteria, also called staph. Treatment with antibiotic creme or pills will typically clear up these problems.

People with diabetes also are more affected by an infection than someone without the disease because they have weakened immune defenses. Studies have shown that persons with diabetes – even those who have moderately elevated blood sugar levels – experience worse outcomes with infections. Thus, early diagnosis and prompt treatment of infections are important.

People with diabetes should be vigilant about any changes in their bodies that could signal an infection. Symptoms of an infection can include a rise in body temperature or change in blood sugars; pain with urination, or cloudy, bloody or foul-smelling urine; difficult or painful swallowing; a foul-smelling vaginal discharge; changes in bowel habits; and warmth or redness at any cut or scrape, including minor trauma locations and surgical sites. Any of these symptoms should be brought to the attention of your doctor.

Fungal Infections

Fungal infection or Candida albicans is a yeast-like fungus which causes a red, itchy rash frequently surrounded by tiny blisters and scales and is usually found in warm, moist folds of the skin under the breasts, around the nails, between fingers and toes, in the corners of the mouth, and in the armpits and groin. Other fungal infections common to people with diabetes include ringworm (a ringshaped ringshaped itchy patch), jock itch, athlete’s foot and vaginal infections. If you think you have a yeast or fungal infection, talk to your doctor about the best medication to treat the condition.

Diabetic Blisters

If you have diabetes and notice blisters on your skin, they are likely diabetic blisters, also known as diabetic bullae or bullosis diabeticourm. Relatively rare, these fluid-filled blisters occur in clusters, typically appear on the legs, feet and toes and can be as large as six inches wide. They resemble blisters that occur when you get a burn, and although they may be alarming when you first spot them, they’re painless and generally heal on their own in about three weeks. The skin surrounding the blister is not normally red or swollen, but can be extremely itchy. Apply antibiotic cream or ointment and keep the blister covered with a bandage to protect it from rupturing. Your doctor may prescribe a steroidal creme if the itching is severe.

Diabetic Dermopathy

Also called shin spots, this condition develops as a result of damage to the blood vessels in the skin. Although the lesions may appear in anyone, particularly after injury or trauma to the area, they are one of the most common skin problems found in patients with diabetes. Dermopathy appears as a shiny, slightly indented round or oval, scaly lesion over the front part of the lower legs. The spots are typically light brown or reddish in color and can be mistaken as age spots. They are not painful, although they can occasionally cause itching or burning. The exact cause of diabetic dermopathy is unknown, and medical treatment is usually not necessary.

Eruptive Xanthomatosis

When blood sugar levels aren’t well controlled and triglycerides (blood fats) rise to extremely high levels, eruptive xanthamosis can occur. This condition presents as firm yellow, pea-like enlargements in the skin and occurs most often on the backs of the hands, feet, arms, legs and buttocks. Each bump has a red halo and may itch. The bumps disappear when diabetes control is restored.

The skin is not only our most visible organ, but also the largest and most vulnerable. Take care of the skin you’re in and avoid diabetes-related skin conditions by keeping your blood sugar under control, practicing good skin care daily and staying alert for signs of skin infections or disorders. And don’t hesitate to call your diabetes team if you see any changes or have any concerns.