Here's a quick biology quiz: what is the largest organ in your body?
It's... your skin! Did you get it right? Despite the fact that your skin is on the outside, it is your largest organ and as we've discussed in previous editions in our 411 on Diabetes Complications series, diabetes can affect every organ in (or on!) your body. This goes for your skin too! With the summer heat barreling down, more of us are exposing our skin. We all know that we need to protect our skin from the sun by using sunscreen, but did you know there are other ways to keep your skin healthy from the damages of diabetes?
Yep. According to the ADA, about a third of people with diabetes will have some kind of skin condition. Fortunately, most of them are easily detectable and treatable if caught early.
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Believe it or not, there are a lot of potential diabetes skin complications, ranging from fairly common (20-30% of PWDs) to extremely rare (less than .5%). We can't dig into all of them in just one post, but here are the highlights of some more common skin complications to keep an eye out for:
- Bacterial Infections: This includes gross things like styes, boils, carbuncles and infections around the nails. Yuck! Bacterial infections will also set in when you have a wound that won't heal, like a foot ulcer. Even blisters can become infected if not properly cared for. Infections are especially common in folks with peripheral diabetic neuropathy, because their wounds are much less likely to heal quickly. Although antibiotics can take care of this quickly, it's important to not let things fester (pun!).
- Fungal Infections: One type of fungal infection, the yeast infection, is common in women with diabetes, but fungal infections can also occur between fingers and toes, around nails, and basically in any warm, moist folds of the skin. This happens a lot during the summer when folks are swimming and sweating, so make sure to keep yourself as dry as possible and extra-clean!
Luckily, these issues are easily treatable with a doctor's visit and antibiotics.
When your blood sugars are high, how do you usually feel? Pretty thirsty, right? So is your skin. High blood sugars can sap your skin of moisture, leading to dry skin. Dry skin can become red and sore, or crack and peel. Infections (see above) can also happen when bacteria enter, cracking skin.
Kathyann, a type 1 PWD at TuDiabetes, says that her itchy skin was particularly bad right before she discovered her diabetes. She writes, "My skin was always dry and itchy before I was diagnosed. I used to scratch my legs til they bled. And slathered on the cortisone creme. My A1c was 14 at the time. Now that my BG is under control, I don't have that symptom anymore."
Moisturizing skin is extremely important, also during the winter months. And if you have chronic dry skin, talk to a dermatologist; you'll probably need prescription cream rather than the over-the-counter stuff.
Personally, I'm pretty pasty white most of the year, but summertime is filled with beach outings, hikes and other outdoor adventures... plenty of opportunities for a little UV damage. Although we know that wearing sunscreen is important to stave off skin cancer, preventing sunburns can also help diabetes. If you've ever noticed wonky blood sugars after a sunburn, you're not crazy for thinking there is a connection. That's because having a sunburn is an injury to the skin, and while the skin is healing, the body is under stress, just like an illness. Crazy high blood sugars from a cold or flu are pretty common, but they can also happen while healing from a sunburn!
A Few Other Skin Conditions:
- Diabetic Dermopathy: Ever heard of this? The condition is marked by small, oval brown or red spots on the lower legs. High blood sugar causes changes to the small blood vessels, which can then leak small amounts of blood into the skin (gross again!). It occurs in about a third of PWDs, but is more commonly found in folks who already have another diabetes complication, like retinopathy, neuropathy or kidney disease. Diabetic dermopathy is said to be harmless, and will usually go away in a few years (!)
- Digital Sclerosis: Also called diabetic thick skin, this causes tight, thick, waxy skin on the hands and fingers (hence the digital) in about 30% of PWDs. In rarer cases, thick skin also appears on the upper back. There isn't a lot you can do about it except use lots of lotion and moisturizers.
- Diabetic Blisters: I'm warning you now: don't Google this! You will not like what you see! Diabetic blisters, also called Bullosis Diabeticorum, are enormous blisters that are found on backs of fingers, hands, toes, feet, legs or forearms. These blisters are fairly rare, only occuring in about .5% of the PWD population, but they seem to affect type 1 PWDs more. Like dermopathy, they're usually found in folks who have another diabetes complication, like diabetic neuropathy or kidney disease. According to the ADA, they are painless, but ugly nonetheless. Like your garden variety blister, don't pop them! They usually heal by themselves with proper blister care, but if an infection happens (see above), talk to your doctor right away about antibiotics.
- Vitiligo: Like type 1 diabetes, Vitiligo is an autoimmune disease. In this case, the immune system attacks melanocytes, which are the cells that create your skin color. People who have vitiglio will often find their skin turning white in spots, primarily on the chest and stomach, but also on the face and hands. Because of the lack of pigmentation, it is especially important to keep up with sunscreen to prevent sunburns on the discolored skin.
Some treatments for Vitiligo include oral and topical medication to help with pigmentation of your skin. Since this is autoimmune, there is no prevention, and it's believed that between 1 and 7% of type 1 PWDs will develop this condition.
Marie B, a type PWD, was diagnosed with Vitiligo the year before her diabetes diagnosis. She says, "I have it on my face, arms, chest, legs, hands. When I was younger, I was really self-conscious about it, but I hardly ever think about it now, except to keep up with the sunscreen... My hands are really affected. I decided to wear nice jewelry and that makes me feel good when I look at my hands!"
The main advice for all diabetes complications is something we all know, but bears repeating: manage your diabetes well, stay informed on your body's changes, and talk to your doctor if anything seems suspicious.
Although the hardcore advice like "Never wear sandals!" or "Don't go barefoot — even around the house!" are a little antiquated, it is important to take care of your skin and wearing properly fitting shoes (most of the time, at least ;) ). For us PWDs, our feet and toes are at high risk for injury because our circulation is sometimes not so good. So if you get a cut from running around the backyard barefoot or have one too many blisters from wearing those super-trendy sandals on your summer vacation, you need to take care of them asap. Use ointment, switch to another pair of shoes, whatever it takes...
Thankfully, unless you have a serious problem with circulation, you probably won't need to wear these. Whew!