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

 

 

(More articles available on the website)

Suggestions, Queries, and Comments are welcome