The skin is the body’s biggest organ, but when people with diabetes think about the complications they might face, skin problems don’t always come to mind. In fact, high blood glucose and the complications it can lead to are associated with a number of skin problems, some of which can become serious if not attended to promptly.
The good news is that keeping blood glucose levels in target range and following a thorough self-care regimen can prevent many skin conditions, help you to identify others early, when they’re most easily treated, and keep you looking and feeling your best. Take this quiz to find out how much you know about how diabetes can affect your skin and what warning signs to look for. (You’ll find answers later in this article.)
1. People with diabetes are more likely to develop which of the following skin conditions? (More than one answer may be correct.)
A. Fungal diseases, such as athlete’s foot.
B. Candida (yeast) infections.
C. Waxy, scaly, or thickened skin.
2. Which of the following diabetes complications can affect the skin? (More than one answer may be correct.)
C. Peripheral vascular disease.
D. High blood pressure.
3. Neuropathy can cause which of the following skin problems in people with diabetes? (More than one answer may be correct.)
A. Decreased sensation.
B. Abnormal sweating.
C. Dry skin.
4. Which of the following skin conditions can be a result of long-term high blood glucose? (More than one answer may be correct.)
A. Diabetic dermopathy.
C. Bacterial infections.
D. Acanthosis nigricans.
5. Which of the following are good ways to prevent skin problems? (More than one answer may be correct.)
A. Bathing or showering regularly.
B. Avoiding skin-care products that contain additives like dyes or fragrances.
C. Keeping blood glucose levels in target range.
D. Maintaining a balanced diet.
1. A, B, C, and D. Fungal diseases such as ringworm can affect the feet (athlete’s foot), groin (jock itch), scalp, or anywhere else on the body. Both fungus and yeast live on the skin under normal circumstances, but they thrive in moist, warm environments and feed on sugar, so when blood glucose is high, they are more likely to grow out of control and cause problems. Yeast is found in skin folds, including those in the underarms, stomach, corners of the mouth, groin, and vagina, and under the foreskin (if uncircumcised) or breasts. It’s important to examine all the “nooks and crannies” of your body for redness, flakiness, whitish material, or foul odor and to seek treatment for these so that a yeast infection does not progress into the blood or body.
Waxy or thickened skin is most common on the lower extremities. Swelling (or fluid retention) in the skin can cause red blood cells to leak out of damaged blood vessels, resulting in a condition called stasis dermatitis. Untreated, the skin can become fibrotic, or scar-like – permanently thicker, waxy, scaly, and discolored. A rarer condition, called scleredema, can also cause these types of skin changes on the neck, upper back, and hands. The causes of scleredema are not well understood, but tight blood glucose control may prevent or improve the condition.
Impetigo is a bacterial infection that is also more common in people with diabetes. It can be found anywhere on the body but is most commonly seen on the face around a mild scrape or cut.
2. A and C. Nephropathy (kidney damage) can cause pruritus, or itching. The skin may be dry and itchy, but with no visible rash, as a result of elevated proteins and enzymes in the blood.
Peripheral vascular disease (PVD) – damage to the blood vessels, most often in the legs – can cause decreased hair growth and “staining” of the skin, or brown patches, on the lower legs and tops of the feet, along with swelling, dryness, and decreased sensation.
High blood pressure can lead to peripheral vascular disease, but does not itself cause skin changes.
Retinopathy does not cause skin problems.
3. A, B, C, and E. Neuropathy (nerve damage) is perhaps best known for causing decreased sensation (numbness) and/or pain in the feet and legs and sometimes hands and arms, but it can have other consequences as well. Nerves are required to stimulate the production of sweat, so you may notice decreased sweating all over your body. This can also cause skin to become cracked and dry. Decreased sensation as a result of neuropathy can contribute to the development of ulcers when cuts, sores, or friction that would normally be painful or irritating go unnoticed. Simply wearing an ill-fitting shoe that rubs on the foot can create a sore that can become an ulcer.
Hives are not related to neuropathy.
4. A, C, and D. Diabetic dermopathy produces clusters of small, round, pink spots that appear on the shins and quickly turn brown and scaly. The spots are painless and may eventually disappear without treatment, but they often leave permanent pigmentation changes.
Bacteria on the skin grow more rapidly in the presence of high blood glucose and can progress deeper into the tissue beneath the skin, causing cellulitis or even sepsis (blood infection). Other bacterial infections that occur with great frequency in people with diabetes are styes (infections of the glands of the eyelid), folliculitis (infections of the hair follicles), boils, and infections around the nails.
Acanthosis nigricans appears as velvety dark plaques around the neck and underarms and other skin folds, or on the face and knuckles. The skin becomes darker because it is thickened by insulin and other growth factors that are elevated in people with Type 2 diabetes. Weight loss, as well as keeping blood glucose in the target range, may improve this condition.
Acne is not related to high blood glucose.
5. A, B, C, and D. Good hygiene is important for everyone. You do not need harsh antibacterial soaps to be clean. Instead, use gentle, additive-free cleansers, and moisturize daily. People with diabetes can be more prone to allergies to additives such as dyes and fragrances. Keeping your blood glucose in the target range helps reduce the chance of infections and can prevent skin changes related to nerve and blood vessel damage (as described in Question 2). Following a healthy diet is good for every organ, including the skin. The vitamins, minerals, and proteins in a balanced diet are required for maintaining healthy skin and especially for repairing injured skin.