Skin problems are often the first visible signs of diabetes, according to the American Diabetes Association. Type 2 diabetes can make existing skin problems worse, and also cause new ones.

Type 2 diabetes is a chronic metabolic condition that affects how your body absorbs glucose (sugar). This happens when the body either rejects insulin or doesn’t produce enough insulin to maintain a normal blood sugar level.

While it’s most common in adults, some children and adolescents can be diagnosed with type 2 diabetes. According to the Mayo Clinic, risk factors include being overweight, having a family history of diabetes, and inactivity.

While there is no cure, patients can manage their type 2 diabetes by eating well, exercising, and (in some cases) taking medications recommended by your doctor. Monitoring your blood sugar is also important. Sometimes even maintaining a healthy weight isn’t enough to manage this condition. In some cases, your doctor will determine that medication intervention is needed.

Common treatments for type 2 diabetes include:

  • insulin therapy (insulin “shots,” usually reserved for those who don’t do well with oral medications)
  • sulfonylureas (medications that stimulate your pancreas to secrete more insulin)
  • metformin (widely prescribed drug which increases the body’s sensitivity to insulin)
  • DPP-4 inhibitors (medications which reduce blood sugar levels)

Long-term type 2 diabetes with hyperglycemia (high blood glucose) tends to reduce blood flow to the skin. It can also cause damage to blood vessels and nerves. Decreased blood circulation can lead to changes in the skin’s collagen. This changes the skin’s texture, appearance, and ability to heal.

Damage to the skin cells can even interfere with your ability to sweat. It can also increase your sensitivity to temperature and pressure. Some glucose-lowering medications may also increase the risk of developing diabetes-related skin problems.

An estimated one-third of people with diabetes will experience a related skin condition. 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
  • cuts or wounds that are slow to heal (slow healing wounds are often entryways for secondary infections), or appear infected

The types of skin conditions caused by diabetes are typically either bacterial or fungal.

Bacterial Infections

Bacterial infections are common for everyone. However, these kinds of infections are especially problematic for people with type 2 diabetes. These skin conditions are often painful and warm to the touch, with swelling and redness. They may increase in size, number, and frequency if your blood glucose level is chronically elevated.

The most common bacteria that cause skin infections are Staphylococcus, or staph, and Streptococcus, or strep.

Serious bacterial infections can cause deep tissue infections called carbuncles. These may need to be pierced 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
  • infected sties (infections around the eyes)
  • folliculitis (infections of the hair follicles)
  • infections around the fingernails and toenails

Fungal Infections

Fungal infections, caused by the spread of fungus or yeast, are also common for all diabetes patients. This is especially true 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, sometimes also covered with white, “cottage cheese”-resembling discharge. 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.

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. These supply nutrition to the skin tissues. When long-term diabetes isn’t well-controlled, skin problems can occur.

Diabetic Dermopathy

Also known as “shin spots,” the hallmark of this condition consists of light brown, oval, or circular scaly patches of skin, often occurring on the shins. These patches are caused by damage to the small blood vessels that supply the tissues with nutrition and oxygen. This skin problem is harmless and does not require treatment. However, it often doesn’t go away, even when blood glucose is controlled. A higher incidence of this condition is seen in patients who also have retinopathy, neuropathy, or kidney disease.

Necrobiosis Lipoidica Diabeticorum (NLD)

Light brown, oval, and circular patches are also a hallmark of NLD. This condition 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, and also tends to occur on the legs.

Digital Sclerosis

This skin condition causes the skin on hands, fingers, and toes to become thick, tight, waxy, and potentially stiff in the joints. Elevated blood sugar can increase the risk of developing digital sclerosis. Lotions, moisturizers, and regulated blood sugar levels can help prevent or treat this condition.

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

This is a skin condition in which tan, brown, or gray areas of raised skin are seen on the neck, groin, armpits, elbows, and knees. It typically affects people who are obese. This condition sometimes goes away 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.

Though there is no cure for diabetes, there are a variety of treatment options that include lifestyle changes, over-the-counter and prescription treatments, and alternative remedies that can help manage the condition.

Over-the-Counter Remedies

Over-the-counter remedies are available for certain types of skin disorders associated with type 2 diabetes. These remedies include:

  • hydrocortisone
  • nonprescription antifungals, like clotrimazole
  • topical steroid medications (mild hydrocortisone)

Prescription Medications

Some skin conditions are severe enough that medical attention and prescription medications are required. Prescription medications and treatments available include:

  • antibiotics (topical or oral) to treat skin infections
  • stronger antifungal medications
  • insulin therapy to help regulate the origin of skin conditions

Alternative Remedies

For those who aren’t interested or don’t need prescription medications, alternative remedies are available for those with type 2 diabetes-related skin problems. These alternative remedies include:

  • talcum powder where skin touches other parts of the skin (armpit, behind the knees)
  • lotion to soothe dry skin can reduce itching
  • aloe vera used topically (not orally)

Before using any natural or alternative remedies, consult your doctor. Even all-natural herbal supplements can interfere with medicine you’re currently taking.

Lifestyle Changes

Though sometimes genetics and other factors come into play, being overweight and inactive can have an effect on diabetes.

Lifestyle changes that can help manage diabetes include:

  • following a healthy diet, including eating more fruits, vegetables, and whole grains
  • maintaining an exercise program, aiming for 30 minutes of cardio, 5 days a week
  • monitor your blood sugar

By learning how your body reacts to certain foods and medications, you can better learn how to maintain a healthy blood sugar level.

Lifestyle changes that can help specifically with type 2 diabetes-related skin problems include:

  • avoid and actively prevent dry skin
  • avoid scratching dry skin, which can create lesions and allow infections to set in
  • treat cuts immediately
  • keep your home humid during dry months
  • avoid hot baths or showers, as they can dry skin out

Each patient is different, so make sure to consult your doctor before changing your diet or exercise program.

There are a fair share of skin disorders associated with type 2 diabetes, some more serious than others. Thanks to multiple different types of medications, alternative remedies, and lifestyle changes, patients can reduce their discomfort and the severity of the conditions.

While some skin conditions associated with type 2 diabetes are mostly harmless and will go away on their own, some can be much more dangerous. If you have a flare-up of a new skin condition listed above, make an appointment to see your doctor as soon as possible.