Diabetes and Skin Health

Skin problems are often the first sign of diabetes, according to the American Diabetes Association. Skin problems of all types, including bacterial infections like boils and carbuncles, are worsened by type 2 diabetes. Besides ordinary skin irritations and chronic dry and/or itchy skin, type 2 diabetes also increases the risk of a variety of specific conditions that range from rare to common in those with diabetes.

Causes of Diabetes-Related Skin Problems

Long-term type 2 diabetes and uncontrolled hyperglycemia (high blood glucose) can reduce blood flow to the skin as well as damage blood vessels and nerves. Decreased blood circulation can lead to changes in the skin’s collagen, altering its texture, appearance, and ability to heal. Damage to the skin’s vascular endothelial cells may even reduce its ability to sweat and increase sensitivity to temperature and pressure. Some glucose-lowering medications may also increase the risk of developing diabetes-related skin complications.

An estimated one-third of diabetics will suffer a skin complication that is the result of or worsened by diabetes. For this reason, people with type 2 diabetes should be watchful for changes in their skin, injuries or irritation to the skin surrounding insulin-injection sites, and cuts or wounds that are slow to heal (slow-healing wounds are often entryways for secondary infections).

Diabetes and Skin Infections

Bacterial infections are common to all people, but can be especially troublesome for people with type 2 diabetes. Bacteria-laden infections of the skin are often painful and warm to the touch, with swelling and redness. They may increase in size, number, and frequency if your blood glucose is repeatedly high. The most common bacteria that cause skin infections are Staphylococcus, or staph, and Streptococcus.

Serious bacterial infections can cause carbuncles (deep-tissue infections) that may need to be lanced by a physician and drained. If you suspect that you have a bacterial infection, notify your doctor immediately so you may be treated with antibiotics. Other common bacterial infections include boils, sties (infections around the eyes), folliculitis (infections of the hair follicles), and infections around the fingernails and toenails.

Fungal infections, caused by the spread of the fungus Candida albicans, or yeast, are also common for type 2 diabetes patients, especially if their blood glucose is not well controlled. Yeast infections look like areas of red, itchy, swollen skin that are surrounded by blistering or dry scales. Yeast fungus thrives in the warm folds of the skin, under breasts, in the groin, in the armpits, in the corners of the mouth, and under the foreskin. Common skin irritations like athlete’s foot, jock itch, and ringworm are fungal infections. They can itch, spread, and worsen if not treated with prescription medication.

Diabetes-Related Skin Conditions

The following list of skin irritations is specific to type 2 diabetics. Most of these conditions are related to changes in the small blood vessels that supply nutrition to the skin tissues. As in diabetic neuropathy (nerve damage), complications to skin are often seen in long-term diabetes that is not well controlled.

Diabetic Dermopathy

The hallmark of this condition are light brown, oval or circular scaly patches of skin that are caused by damage to the small blood vessels that supply the tissues with nutrition and oxygen. Diabetic dermopathy is harmless and does not require treatment, but it often doesn’t disappear, even when blood glucose is controlled. A higher incidence of diabetic dermopathy is seen in patients who also have retinopathy, neuropathy, and/or kidney disease.

Necrobiosis Lipoidica Diabeticorum (NLD)

Light brown, oval and circular patches are also a hallmark of NLD, a condition that is rarer than diabetic dermopathy. In the case of NLD, though, the patches are often larger and fewer. Over time, NLD skin patches may appear shiny with a red or violet border. They are usually itchy and painful. As long as the sores do not open, no treatment is required. It affects adult women more often than men.

Atherosclerosis

Atherosclerosis is a hardening or thickening of the arteries that causes changes to the skin on the legs, even in young people. Because atherosclerosis interferes with blood flow and circulation to the lower extremities, feet and toes may become cold and hairless, and the skin may appear shiny. Toenails often become thick and hard to trim. People suffering with atherosclerosis may also have difficulty exercising because lack of oxygen to the calf muscles causes pain. Diabetics with atherosclerosis often also have nerve damage to the feet and/or hands.

Because neuropathy can make a person more prone to injury, you should examine and care for your feet regularly. Be wary of cuts or wounds that aren’t healing well or quickly. Any cuts or wounds that are open can lead to secondary infections.      

Disseminated Granuloma Annulare

These red or skin-colored raised bumps look like rashes and commonly appear on the hands or feet. They may be itchy. They are harmless, and medications are available for treatment. 

Acanthosis Nigricans

Typically affecting those who are obese, acanthosis is a skin condition in which tan or brown areas of raised skin are seen on the neck, groin, armpits, elbows, and knees. This condition sometimes disappears when a person loses weight.     

Diabetic Blisters

Although rare, type 2 diabetics with nerve damage may also get blisters that look like burns. They usually heal in a few weeks and are not painful. Blisters of this type typically occur only if blood glucose is not controlled.