Introduction to Diabetes and Skin Problems

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Introduction to Diabetes and Skin Problems

Diabetes patients do not have a monopoly on skin problems. Hardly! Walk into any pharmacy or supermarket and you will find aisles overflowing with emollients, creams, astringents, and salves -- evidence that damaged skin is a consuming cosmetic and medical concern for the general population.

However, having diabetes appears to increase the risk for rashes, sores, and other conditions that affect your facade. According to the American Diabetes Association, about one-third of patients will develop a skin disorder at some point. The skin on your lower extremities is particularly vulnerable to problems.

This article will explain many skin conditions, but to start out you'll learn how your skin is made up on the next page.

For more information on diabetes, try the following links:

• Diabetes and Foot Problems: The lower extremities are particularly vulnerable to diabetes complications. Find out why.
• Diabetic Neuropathy: This form of nerve damage causes many skin problems. Find out about it here.
• Diabetes Symptoms: Some people have diabetes and don't know it. Learn how to tell if you need treatment.
• Diabetes: This disorder in the blood can affect most of your organs. Learn how it works here.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE.

How Diabetes Affects the Skin

Skin may seem pretty simple -- a shallow layer keeping everything in one place. But it's actually complex and delicate. Diabetics in particular need to be mindful of skin conditions.

High blood sugar can dry out and damage your skin.

As every child learns in school, the skin is the largest organ in the body. Your hide has a surface area of about two square yards and weighs about 10 pounds. Technically, you could say that the skin is the largest organ on the body, since it acts as a protective covering for your bones, muscles, and organs. However, the skin is more than mere armor, with many of its critical roles performed below the exterior.
 
The body's outer shell, called the epidermis, is made up of a top layer of skin cells that are dead. That's just as well, since they are constantly flaking and peeling off anyway. Fortunately, the body replaces these so-called horny cells just as quickly with new ones, as cells in the lower layer of the epidermis divide. Some cells in the epidermis produce melanin, the pigment that provides skin color.

Beneath the epidermis lies the dermis. Hidden from sight, this layer is packed with vital equipment that keeps the skin healthy and performs various functions. In the health-and-beauty department, there are hair follicles and sebaceous glands, which produce oil called sebum that moistens the skin. The dermis also contains nerve endings, which detect pain and pressure and govern the sense of touch. They also sense temperature, advising the brain when it's time to slip on a sweater or change into shorts.

Furthermore, the dermis is home to sweat glands, which help regulate body temperature by producing cooling perspiration. Blood vessels constrict to conserve body heat when you're cold, along with their usual duties of providing nourishment to all of the skin and its various structures.

The third and innermost tier of the skin is called the subcutaneous layer. Mostly made up of fat, it provides insulation and protects bones and organs from bumps and bangs.

How Diabetes Affects Your Skin

High blood sugar can rough up smooth skin in several ways. Elevated glucose results in high levels of compounds called advanced glycosylation end products (AGEs), which damage nerves and blood vessels that are necessary to keep skin healthy. However, your body's defense against high blood sugar may cause collateral damage to the epidermis.

The first two major conditions we'll discuss on the next two pages, dry skin and skin infections, are common medical problems that can affect anyone, whether they have diabetes or not. However, people who have the disease are far more likely to develop these skin conditions. Many lesser-known skin problems primarily afflict diabetes patients.

We'll start off with dry skin. The next page explains how diabetes can dehydrate you, and what to do to keep your skin healthy.

Monitoring the Health of Your SkinIf you have always wanted to splurge on a full-length mirror, now would be the time. A good handheld mirror would help, too. Using these tools to examine every inch of your skin daily can help detect small problems before they turn really ugly. Talk to your doctor if any of the following skin changes occur and persist: Itchiness Redness, inflammation Scaliness Lumps, especially if they leak discharge (which is a nicer word than "pus") Pain Discoloration, blotches, or any other changes in appearance Blisters Shininess, hair loss "Thick" skin

 

For more information on diabetes, try the following links:

• Diabetes and Foot Problems: The lower extremities are particularly vulnerable to diabetes complications. Find out why.
• Diabetic Neuropathy: This form of nerve damage causes many skin problems. Find out about it here.
• Diabetes Symptoms: Some people have diabetes and don't know it. Learn how to tell if you need treatment.
• Diabetes: This disorder in the blood can affect most of your organs. Learn how it works here.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

Diabetes and Dry Skin

Dry skin can afflict anyone, but diabetics are particularly susceptible. In fact, dryness is one of two major skin condition caused by the increased blood sugar levels of diabetes.

If you spend all day scratching and your skin would make an iguana blush, chances are you're going to flunk your next blood-sugar test. When glucose levels rise too high, the body tries to get rid of the excess sugar through frequent urination. The more you urinate, the more fluid your body loses. If you don't replace that lost fluid by guzzling lots of water, you become dehydrated, which causes (among other symptoms) dry skin.

As good as a hot shower feels, staying in one too long can actually dry out your skin.

As skin loses moisture, it becomes itchy. In severe cases, red scales may form. Scratching can cause sores to crack, opening the skin to an invasion of infectious bacteria. Damage to blood vessels and nerve endings in the skin from high glucose levels makes matters worse.

Of course, you don't need diabetes to develop dry skin. But people with diabetes need to be particularly wary of the environmental influences that can turn anyone's skin to parchment. In cold climates, winter is a worrisome time, since heating systems sap the air of indoor humidity and cold winds chap the skin. Hot showers or baths with soaps and shampoos strip sebum from the skin any time of year.

How To Prevent Dry Skin

Shorten your showers. Long, hot showers or baths may feel great, but they strip away natural oil that keeps skin soft and moist. Bathe in warm water, use mild soap and shampoo, and don't linger too long. Pat dry with a towel. And don't overdo it: Cleanliness may be next to godliness, but bathing too frequently will dry your skin.

Stay well lubed. Apply skin moisturizer after you bathe. Ask your doctor to recommend a brand. Slather the stuff on liberally everywhere except between the toes, which should be kept dry to avoid the nasty fungal infections you'll read about later.

Drink up. Water, that is, to keep your body well hydrated.

Get misty. Unless you live in a tropical climate, use a humidifier to keep the air in your home and workplace from becoming dry during cold winter months.

The other major skin condition associated with diabetes is skin infections. On the next page you'll learn about boils, athlete's foot and other infections.

Dry Skin: Is It Your Meds? Many commonly prescribed drugs can cause dry skin. Talk to your physician if your skin is parched and you take prescription medications, especially any of these: Statin drugs, such as atorvastatin (Lipitor) and simvastatin (Zocor), which lower cholesterol Nicotinic acid (niacin), used to increase HDL ("good") cholesterol Diuretics, used to lower blood pressure Isotretinoin (Accutane), prescribed to treat acne Etretinate (Tegison), prescribed to treat psoriasis. Dry skin can also be a side effect of diuretics.

 

For more information on diabetes, try the following links:

• Diabetes and Foot Problems: The lower extremities are particularly vulnerable to diabetes complications. Find out why.
• Diabetic Neuropathy: This form of nerve damage causes many skin problems. Find out about it here.
• Diabetes Symptoms: Some people have diabetes and don't know it. Learn how to tell if you need treatment.
  • Diabetes: This disorder in the blood can affect most of your organs. Learn how it works here.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE.

Diabetes and Skin Infections

 

People with diabetes need to be careful to avoid dry skin and skin infections. The latter can take many forms, as described on this page.

Skin infections can afflict anyone, just like dry skin can, though doctors agree that having diabetes greatly increases the risk for an invasion of microscopic meanies. The bacteria called Staphylococcus aureus (better known as staph) and the fungus Candida albicans cause many of the skin infections that are most common among people with diabetes.

Some of the more common bacterial skin infections to watch out for include these:

Boils. (Warning: The following definition gets pretty icky, fast.) Boils are painful red lumps that usually occur when bacteria infect a hair follicle. As inflammation worsens, the boil fills with pus and forms a yellow head before rupturing and draining. (Told you so.) Any part of the skin can develop a boil, though these ghastly little sores seem to like hairy areas, for obvious reasons, especially where you sweat a lot. (That means that the face, neck, armpits, and other sweat-inducing zones are most likely to get "boiled.")

Treatment: Hot compresses may relieve pain and make a boil heal faster. If a painful boil persists, see a doctor, who may drain the sore and give you a prescription for antibiotics. Above all, don't squeeze or pop a boil, which could worsen an infection.

Carbuncles. When a bunch of boils gang together, they form a carbuncle.

Treatment: Carbuncles are more serious than single boils, so see a doctor.

Sties. A sty is like a boil, only it forms on the edge of or under the eyelids. A sty may be painful or grow large enough to block vision.

Treatment: Warm compresses may relieve pain and encourage a sty to shrink, but see a doctor if the problem persists. Antibiotic creams can help heal a sty and prevent recurrence. Never squeeze or pierce a sty.

Athlete's foot can afflict anyone. After you thoroughly clean your feet to get rid of it, make sure to keep them dry.

Some of the more common fungal infections (also known as tinea corporis) to afflict people with diabetes include these related conditions:

Athlete's foot. You don't have to be a super-jock to get this itchy, scaly menace.

Jock itch. Likewise, you don't have to wear an athletic supporter to develop this uncomfortable condition, though those snug-fitting protective garments can contribute to the problem (which explains why jock itch usually afflicts males). Also known as tinea cruris, the problem begins as an itchy red rash around the genitals, which can spread to the inner thigh.

Ringworm. As the name suggests, this fungal infection forms ring-shape scales on the skin that may itch. (Fortunately, it doesn't mean you have worms, though having an infectious fungus is nothing to brag about.) Ringworm often develops on the scalp, though it can turn up on other parts of the body. Ringworm of the toenails and fingernails, called onychomycosis, is a common problem. The nails turn thick and discolored, and there's not much your manicurist can do about it.
 
Fungal infections can turn up on other parts of the body. Over-the-counter medications may help, but your physician can prescribe a more powerful antifungal drug to clear up persistent problems.

How To Prevent Skin Infections

Keep it clean. We know, we know, on the previous page we just got done telling you that bathing too often can worsen dry skin. But that doesn't mean you should turn into Pigpen. A thorough daily cleaning will keep bacteria at bay.

Keep it dry. Again, isn't dry skin a threat? Yes, but so are dark, damp places on the body, such as between the toes and under your arms, where fungus can grow. Using a little talcum powder on areas where skin rubs against skin isn't a bad idea.

There are some skin diseases that are particular to diabetics. Find out what acanthosis nigricans, vitiligo and other conditions are about on the next page.

For more information on diabetes, try the following links:

• Diabetes and Foot Problems: The lower extremities are particularly vulnerable to diabetes complications. Find out why.
• Diabetic Neuropathy: This form of nerve damage causes many skin problems. Find out about it here.
• Diabetes Symptoms: Some people have diabetes and don't know it. Learn how to tell if you need treatment.
• Diabetes: This disorder in the blood can affect most of your organs. Learn how it works here.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE.

Rare Diabetes Skin Complications

Some skin conditions are particular to diabetics. Recognizing them can help you get prompt medical attention and prevent needless worry.

The following conditions are less common than dry skin and skin infections (some are downright rare). Some are merely cosmetic problems, while others produce physical symptoms.

Acanthosis Nigricans (AN)

This condition produces thick, dark patches on the body; doctors sometimes say the skin appears velvety. The armpits, back, neck, and other regions prone to sweating are most often afflicted. AN may occur because an unknown "trigger" in the body causes skin cells to accumulate. Some doctors believe excess insulin is one potential trigger, which may be why AN appears to be more common in people with type 2 diabetes. In fact, while AN doesn't hurt or itch, it's a signal to doctors that a patient may have insulin resistance.

(A rare form of AN has been linked to cancerous tumors.) Given its association with type 2 diabetes, it's no surprise that AN is more common in obese people; it also seems to be more prevalent in people with dark skin.

The treatment for diabetes -- injecting insulin -- can cause bumps and bruises, just as the disease can cause skin problems.

Bumps and Bruises

If you inject insulin, you may develop bruises or swollen lumps of fat (known as lipohypertrophy) if you don't rotate injection sites on the skin.

Diabetic Blisters

Sometimes called bullosis diabeticorum, this uncommon problem is most likely to afflict someone with diabetic neuropathy, or nerve damage that is caused by elevated blood sugar levels. Blisters, like those you might get from a serious burn, may form on the hands, fingers, arms, legs, feet, or toes. Although they are usually painless, diabetic blisters may be alarming. If you get one, though, don't worry; they will usually heal on their own, especially if you get your blood sugar under control.

Diabetic Dermopathy

This common diabetes-related skin problem is also known as "shin spots," since it usually appears on the front of the lower legs. The shiny round or oval brown spots develop as tiny blood vessels in the legs narrow and thicken. Shin spots are usually harmless other than mild itching or burning, so they don't require treatment.

Diabetic Thick Skin

No one likes being called "thin skinned," but your doctor isn't paying you a compliment if he or she says your skin is thick. It's not clear why, but diabetes patients tend to have thicker-than-average hides. The problem can take one of several forms. In digital sclerosis, the digits in question are the fingers and toes, but this term includes the back of the hands, too. The skin not only thickens; it turns waxy-looking and feels tight. The joints may stiffen, too. When the skin on the back of the neck or upper back thickens, doctors call the problem scleroderma diabeticorum. Lotions or moisturizers may help soften the skin.

Disseminated Granuloma Annulare

Similar in appearance to necrobiosis lipoidica diabeticorum, this condition causes a ring-shape rash that is red, brown, or sometimes simply a slightly different shade than one's skin. It can spring up on the trunk, neck, arms, legs, and even the ears. If the rash is hidden from sight, you may not require any treatment, since it doesn't ache or itch. To treat the condition for cosmetic purposes, doctors usually prescribe steroids.

Eruptive Xanthomatosis (EX)

As the name suggests, eruptive xanthomatosis creates bulging deposits of yellowish fat in the skin. The thinner the skin, the more noticeable the eruption, which is why the eyelids are so commonly affected (a problem doctors call xanthelasma). However, EX can pop up in other parts of the body, particularly the buttocks. In addition to itching, the lumpy skin is usually rimmed in red. This is not many people's idea of an attractive look, but EX is more than a cosmetic concern. These skin eruptions form when unhealthy levels of fats called triglycerides build up in the blood because your body has become resistant to insulin and cannot get rid of them. In other words, lumpy skin may be the least of your worries. Treatment consists of eating a healthy diet and taking medication to control glucose and blood fats.

Necrobiosis Lipoidica Diabeticorum (NLD)

This rare condition produces blotches on the skin, too, in the form of large, reddish-brown, scarlike sores. Over time, the sores may turn yellow. NLD can be itchy and painful. (Patients without diabetes may develop the condition, in which case doctors just call it necrobiosis lipoidica.) NLD is three times more common in women than in men. No one knows why or what causes the condition. However, it appears to occur as collagen (fiber that holds cells together) breaks down beneath the skin. There is no treatment for NLD, but if a sore breaks open, it requires prompt medical attention.

Vitiligo

Certain diseases, including type 1 diabetes, seem to predispose people to developing this harmless but cosmetically bothersome skin condition. Like type 1 diabetes, vitiligo is an autoimmune disorder, meaning it occurs when the body's immune system mistakenly attacks healthy cells. In this case, the victims are melanocytes, cells that make skin pigment. Vitiligo produces pale patches of discolored skin. The hands, arms, and other parts of the body that receive a lot of sun exposure are most commonly affected, though any portion of your epidermis is vulnerable.

Yellow Skin

No one is certain why, but people with diabetes occasionally develop a yellowish hue to their skin and nails. According to one theory, the problem occurs because some varieties of those irksome advanced glycosylation end products (AGEs) we talked about earlier are yellow in color. If your glucose isn't under control, AGEs accumulate in the blood, which may tint the skin. Although having jaundiced skin is no fun, there is no treatment other than regaining control over blood sugar.

Diabetics have to pay close attention to their skin to make sure they don't develop unhealthy conditions. However, as you've seen in this article, managing your illness to avoid these conditions is relatively easy.

For more information on diabetes, try the following links:

• Diabetes and Foot Problems: The lower extremities are particularly vulnerable to diabetes complications. Find out why.
• Diabetic Neuropathy: This form of nerve damage causes many skin problems. Find out about it here.
• Diabetes Symptoms: Some people have diabetes and don't know it. Learn how to tell if you need treatment.
• Diabetes: This disorder in the blood can affect most of your organs. Learn how it works here.

ABOUT THE AUTHOR:

Timothy Gower is a freelance writer and the author of several books. His work has appeared in many magazines and newspapers, including Prevention, Health, Reader's Digest, Better Homes and Gardens, Men's Health, Esquire, Fortune, The New York Times, and The Los Angeles Times.

ABOUT THE CONSULTANTS:

Dana Armstrong, R.D., C.D.E., received her degree in nutrition and dietetics from the University of California, Davis, and completed her dietetic internship at the University of Nebraska Medical Center in Omaha. She has developed educational programs that have benefited more than 5,000 patients with diabetes. She specializes in and speaks nationally on approaches to disease treatment, specifically diabetes.

Allen Bennett King, M.D., F.A.C.P., F.A.C.E., C.D.E. is the author of more than 50 papers in medical science and speaks nationally on new advances in diabetes. He is an associate clinical professor at the University of California Natividad Medical Center and cofounder and medical director of the Diabetes Care Center in Salinas, California.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE.