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  • Aug 03, 2018

Diabetes and Skin care

Whether you are a diabetic or not, the following information will provide you with basic knowledge needed to take care of your own skin and that of the people having diabetes or running a risk of developing this condition. Incidence of Diabetes is now at an all time high with India being regarded as the diabetic capital of the world.


Diabetes or “sugar” manifests itself in myriad presentations. Surprisingly enough, it is one of those diseases that happen to be diagnosed accidentally as the affected individual is more likely to have approached healthcare provider for a seemingly different reason. Since our skin is highly sensitive to changes in blood sugar levels, it very often gets involved in diabetes. There is research based evidence to prove that 30-70% of diabetics develop skin problems. That explains why it is so important to pay attention to the skin for diabetics or those at risk. The sensitivity of skin ranges from subtle to established changes which can precede or accompany raised blood sugar levels.

Diabetics are prone to develop several skin conditions some of varying frequency and severity. Therefore, being alert to such changes is so important. The skin changes in diabetes have been presented hereunder in a tabulated symptom-matched body-region wise format.

Symptom(s)

Body Regions

Basis

Significance

Probable correlation

Excessive redness of skin

Face

Around hand nails

Changes related to red blood cells

Non specific change

Pre-diabetic

status

Yellowing of skin

Skin

Nails

Biochemical changes

Non specific changes

 

Increase in skin thickness

Reduced finger joint movements (stiff hands)

Reduced skin wrinkling

Upper limbs

Hands (knuckles) and Feet

Lower Limbs



Changes in skin protein structure of skin

 

Increases with duration of disease

Neck

Upper back

 

Scleredema

 

Blurred vision

Spots or floaters

Dark or empty spot in the center of vision

Difficulty in night vision




Eyes

Damage to the site of image formation in the eye

Retinopathy

May be due to diabetes

Raised blood pressure

Edema feet

Loss of appetite

Tiredness

Kidneys

Damage to the kidney

Nephropathy

Risk increases with age

Possible diabetic change

Abnormal sweating

Burning

Tingling

Numbness

Itching

Fractures

Wasting of foot muscles

Ulceration

Feet

Lower limbs








 

Sensory Neuropathy

Motor Neuropathy

Neuropathic ulcers



Sensory and motor neuropathy tend to coexist

Possible diabetic change

Feet

Nerve damage

Ulcers

 

Colorless or porcelain white patches on skin





Ring or arc shaped rashes





Yellow waxy itchy bumps




Shiny and thin reddish brown spots on skin





Painless self-healing ulcers

Any area of body








Vitiligo




Skin involvement is very common with Diabetes. Most skin conditions preventable and treatable


Possible diabetic change

Finger

Ears

 

Granuloma Annulare



Eyes

Elbows

Face

Buttocks

Limbs

Abnormal fat metabolism

Xanthomatosis

Risk of serious pancreatic inflammation

Lower legs



 

Dermopathy



Commonest skin change

Tends to become bilateral

Possible diabetic change

Hands

Feet

Legs

Forearms

Nerve dysfunction and defect in blood circulation

Bullous Diabeticorum

Nerve dysfunction

Hair loss

Thinning

Slow healing


Repeated infections

Boils

Styes

Itching and redness

Pain

Ulceration







Porcelain white

appearance of skin

Legs

Feet

Plaque Build-up



Blood vessel changes

Consult your dermatologist

Hairy areas

Eyes

Reduced capacity to fight off infections

Bacterial

Consult your dermatologist

Genitals

Angles of mouth

Fingers

Toes

Inter digital areas

Nails

Groins

Nose

 

Candididasis

Angular Cheilitis

Tinea

Consult your dermatologist

Lower legs

Changes in protein and fat metabolism

Necrobiosis Lipoidica

Consult your dermatologist

Darkening

Thickening

Skin folds of Neck

Hollow of Armpits

Areas under Breast

Groins/Others

Changes in the skin structure

Acanthosis Nigricans

As a marker of insulin resistance

 

Some of the common and potentially serious skin problems that affect diabetics are given hereunder. Most of these conditions respond to diabetes control  using adequate medication and other supportive measures.

  • Sclredema Diabeticorm
  • Acanthosis Nigricans
  • Necrobiosis Lipoidica
  • Vitiligo
  • Digital Sclerosis and
  • Eruptive Xanthomas

Certain conditions that affect non-diabetics as well but can get unusually bothersome in diabetics are allergies, blisters, and bacterial or fungal infections.

Scleredema Diabeticorum presents as patches of thickened skin over the nape of the neck and upper areas of back of trunk. It can be controlled with proper control of diabetes and moisturizers in most cases.

Acanthosis Nigricans presents as a soft thickening of the skin having velvety touch, and darkening of the affected skin of body folds like neck, armpits, groin, inside of elbows/knees and under breasts. The skin may or may not be raised. It can also appear  over knuckles of fingers when it is usually considered as an indicator of impending insulin resistance. The condition is commoner in the overweight diabetics.

Necribiosis Lipoidica affects the skin of lower legs in the form of well demarcated patches that show thinned out and reddish skin. In some cases, the sores may develop which is an indication for specific treatment as tends to heal spontaneously.

Vitiligo is apparent as porcelain white skin patches appearing slowly over any of the body regions with variable sizes that show total loss of skin color but no other changes like thickening, firmness, or loss of sensations. Generally, these patches are asymptomatic but exposure to sun might inflame them due to loss of protective skin pigment which is responsible for normal skin color and is a protective mechanism to save the skin from harmful sunrays.

Digital Sclerosis presents as thickening and firmness of fingers with finger stiffness posing difficulty in movement of affected joints.

Eruptive Xanthomas are seen as yellow, waxy bumps on the face, body creases, and sometimes on buttocks.

Allergies, blisters, and bacterial or fungal infections require standard treatments but with greater emphasis on hygiene, customized approach in the use of antibiotics or antifungal medication, longer period of observation, and education on prevention with special measures for diabetics.

It is important to understand as to why diabetics have a greater risk of developing skin ailments. Diabetes is a chronic disease that takes a toll on the disease fighting capacity of the body. Since sugar acts as an excellent medium for growth of germs, therefore diabetics are at a higher risk of getting infections. This implies that a diabetic has to expend more disease fighting capacity to ward off these germs. Secondly, diabetes causes damage to many organs like kidney, eyes, and nerves by causing thickness of various membranes and altering their metabolism. Due to damage to various structures in the body, the blood supply and the sensations in diabetics tend to become impaired. Some diabetics develop reduced sensitivity to pain and temperature sensations. The collective impact of these changes makes diabetics prone to sluggish repair of the injured body  organs and recurrent infections.

The good news is that diabetics can take sufficiently good care in preventing and self-managing their skin problems so as to live a comparatively healthier life. The key is to maintain optimal blood sugar levels. This can be achieved with proper diet, exercise, and medication. Paying attention to body hygiene is yet another important measure with which they can protect themselves from skin diseases. Studies have indicated that nearly all diabetics encounter one or more skin related concern at some stage of their disease attributable to their diabetic status. As lower limbs and feet tend to bear the brunt of blood circulation and nervous system dysfunction, so it is important for them to wear well fitting shoes and to visually examine their skin before and after every use of footwear. They need to pay greater attention to inter digital spaces (between toes and fingers) and bony prominences. Diabetics should refrain from frequent immersion of hands in water, corrosive liquids like soaps, detergents, or chemicals.

Prevention is definitely better than cure!

 

Note:

 

You are permitted to share, distribute, print, or reproduce this article for private use with proper citation of the source. The article is a part of our service to fellow human beings as a means of health education and awareness enhancement to minimize dependence on healthcare

 

Dr Vinay Kumar

Senior Consultant Dermatologist

vnykmrrr123@gmail.com

www.yourskinmyconcern.com

+91-93 199 299 00

 

 

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