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Understanding type 2 diabetes

Skin problems are often the first visible signs of diabetes, according to the American Diabetes Association (ADA). 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 utilizes glucose (sugar). This happens when the body either doesn’t respond normally to 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 have type 2 diabetes. Risk factors for the condition include being overweight, having a family history of diabetes, having a history of gestational diabetes, and inactivity.

While there’s no cure, some people can manage their type 2 diabetes by eating well and exercising. Monitoring your blood sugar is also important.

Sometimes maintaining a healthy weight isn’t enough to manage this condition. In those cases, a doctor will determine that medication intervention is needed.

Insulin injections, oral drugs, and non-insulin injectables are some common treatments for diabetes.

Long-term type 2 diabetes with hyperglycemia, or high blood glucose, tends to be associated with poor circulation, which reduces blood flow to the skin. It can also cause damage to blood vessels and nerves. The ability of the white blood cells to fight off infections is also decreased in the face of elevated blood sugar.

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.

Diabetic neuropathy can cause decreased sensation. This makes skin more prone to wounds that may not be felt and therefore come to your attention at a later stage.

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Candidiasis skin infection in a skin fold.
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Oral thrush is a yeast infection that can develop from unmanaged diabetes.
Adam Januszczak / Alamy Stock Photo
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A collection of pus located underneath the skin and centered on a hair follicle is called a furuncle, also known as a boil.
Photo By DermNet New Zealand
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A stye is also called a hordeolum. It occurs when there is an infection of the glands in the eyelid. It can appear as red, painful, and swollen bump on the eyelid.
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Folliculitis appears as pus bumps located on hair follicles.
Photo by DermNet New Zealand
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Paronychia is the medical term for an infection around the nail fold. It is called “acute” when it has been present for less than six weeks. It can sometimes be very painful and swollen. Acute paronychia is usually caused by a bacterial infection.
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Sometimes people with diabetes can have thickening of the skin on the hands or fingers as well as decreased ability to move the joints, which is called diabetic cheiroarthropathy.
Photo by Pandey A, Usman K, Reddy H, Gutch M, Jain N, Qidwai S – Annals of medical and health sciences research (2013)
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Necrobiosis lipoidica is a rare disorder that can be seen in people with diabetes, typically on the shins. It is unknown why it occurs.
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Diabetic dermopathy is a type of skin condition that can commonly occur on the shins as reddish-brown patches.
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A relatively uncommon condition called granuloma annulare can sometimes be quite extensive and has been thought to possibly be associated with diabetes.
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Acanthosis nigricans appears as a darkening of the skin and is a common skin manifestation of diabetes. A typical area to see this is around the neck.
down syndrome, acanthosis nigricans, neck, Acanthosis nigricans

Between 51.1 and 97 percent of people with diabetes will experience a related skin condition, according to a recent literature review.

For this reason, people with type 2 diabetes should watch out for:

  • changes in their skin
  • injuries or irritation to the skin surrounding insulin injection sites
  • cuts or wounds that are slow to heal, as slow-healing wounds are often entryways for secondary infections
  • cuts or wounds that appear infected

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

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 doctor 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
  • styes, or infections around the eyes
  • folliculitis, or 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 people with diabetes. This is especially true if their blood glucose isn’t well-controlled.

Yeast infections look like areas of red, itchy, swollen skin that are surrounded by blistering or dry scales. The scales are sometimes also covered with white discharge that resembles cottage cheese.

Yeast fungus thrives in the following areas:

Common skin irritations such as athlete’s foot, jock itch, and ringworm are fungal infections. They can itch, spread, and worsen if not treated with prescription medication.

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Most skin irritations specific to people with type 2 diabetes are related to changes in the small blood vessels. These supply nutrition to the skin tissues.

Also known as “shin spots,” the hallmark of diabetic dermopathy is light brown, scaly patches of skin, often occurring on the shins. These patches may be oval or circular.

They’re caused by damage to the small blood vessels that supply the tissues with nutrition and oxygen. This skin problem is harmless and doesn’t require treatment. However, it often doesn’t go away, even when blood glucose is controlled.

A higher incidence of this condition is seen in people who also have retinopathy, neuropathy, or kidney disease.

Light brown, oval, and circular patches are also a hallmark of necrobiosis lipoidica diabeticorum (NLD).

This condition is rarer than diabetic dermopathy. In the case of NLD, though, the patches are often larger in size and fewer in number. Over time, NLD skin patches may appear shiny with a red or violet border. They’re usually itchy and painful.

As long as the sores don’t open, no treatment is required. It affects adult women more often than men, and also tends to occur on the legs.

This skin condition causes the skin on the 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 the condition.

Disseminated granuloma annulare (disseminated GA) appears as red or skin-colored raised bumps that look like rashes, commonly on the hands or feet. These bumps may be itchy.

They’re harmless, and medications are available for treatment.

Acanthosis nigricans (AN) is a skin condition in which tan, brown, or gray areas of raised skin are seen on the following parts of the body:

  • the neck
  • the groin
  • the armpits
  • the elbows
  • the knees

This condition typically affects people who are obese and is a marker of insulin resistance. It sometimes goes away when a person loses weight.

Although rare, people who have type 2 diabetes and nerve damage may also get blisters that look like burns. They usually heal in a few weeks and aren’t painful.

Blisters of this type typically occur only if blood glucose isn’t controlled.

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

OTC remedies

OTC remedies are available for certain types of skin disorders associated with type 2 diabetes. These remedies include:

Prescription medications

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

  • antibiotics, either 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 to treat type 2 diabetes-related skin problems. These alternative remedies include:

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.

These are a few lifestyle changes that can help manage diabetes:

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:

  • avoiding and actively preventing dry skin
  • avoiding scratching dry skin, which can create lesions and allow infections to set in
  • treating cuts immediately
  • keeping your home humid during dry months
  • avoiding hot baths or showers, as they can dry skin out
  • inspecting feet daily, especially if neuropathy with diminished sensation is present

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

There is a fair share of skin disorders associated with type 2 diabetes, some more serious than others. Thanks to multiple types of medications, alternative remedies, and lifestyle changes, people with type 2 diabetes 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.