People with diabetes are more prone to skin problems than people who do not have diabetes. This is largely due to fluctuations in blood glucose levels. When blood glucose levels are high, the body loses fluid and the resulting dehydration can lead to dry skin on the legs, feet and elbows. Dry skin can crack, letting germs that can cause infections into the body. High blood glucose levels also lower resistance to infections and slow healing, which, in turn, can increase the risk of skin infections or boils. These may take a long time to heal.
Because people with diabetes often have reduced nerve sensitivity and circulation in their hands and feet, it can sometimes be difficult to identify skin problems. What’s more, the nerve damage associated with diabetes can cause a decrease in sweating, which helps to keep skin soft and moist. Decreased sweating in the feet and legs can cause dry skin.
As many as one-third of people with diabetes will have a skin disorder caused or affected by diabetes at some time in their lives. In fact, such problems are sometimes the first sign that a person has diabetes. Rough, dry and scaly skin affects at least 75 percent of people over the age of 64 who have diabetes.
Skin disorders associated with diabetes
Necrobiosis lipoidica diabeticorum is caused by changes in skin cells, which are associated with blood flow through the body’s tiny blood vessels called capillaries. It first appears as a dull, raised area of fairly large spots or sores; after a while, it develops a shiny surface, similar to a scar. It may be yellow-brown to purple, with a pronounced violet or purple border. The skin may get thin and crack, but usually heals, often leaving a brownish depressed scar. It is associated more with type 1 diabetes than type 2.
Also called shin spots, diabetic dermopathy involves the appearance of small, round lesions that are raised at the edges, which may also crack. Dermopathy, caused by changes in the small blood vessels, often looks like light brown, scaly patches and may be oval or circular. Some people mistake them for age spots. The patches do not hurt, open up or itch.
Bullosis diabeticorum are small to large nodules blisters that develop underneath the skin and may rupture. While they are sometimes quite large, they are usually painless. There is no treatment and the blisters heal on their own, usually within three to four weeks and tend to leave no scars. The best way to prevent and treat these blisters is to maintain good blood glucose control.
Most often associated with being overweight, Acanthosis nigricans causes velvety, light brown to black markings, usually on the neck, under the arms or in the groin. In most cases, elevated levels of insulin cause acanthosis nigricans by activating insulin receptors in the skin and forcing the skin to grow abnormally. Reducing the circulating insulin through a special diet can lead to a rapid improvement.
Tips for keeping skin moist
- Keep blood glucose levels under good control (4 – 7 mmol/L before eating; 5 – 10 mmol/L two hours after eating).
- Drink plenty of fluids.
- Bathe or shower in warm (not hot) water, as hot water can dry out skin.
- Avoid taking long baths and washing excessively, as this can also cause loss of oil in the outer layers of the skin, causing further dryness.
- Dry skin well after bathing or showering and then check for any areas that may be slightly red or particularly dry, as they may need special attention. (If this is the case, ask your doctor for a referral to a dermatologist for special treatment.)
- If possible, take fewer showers/baths in the winter to preserve your skin’s moisture, as skin is drier during this time than in other months.
- Keep skin moist by using a lotion or cream after bathing.
- Wear cotton underwear, as it allows air to circulate better than synthetic materials
- Use a humidifier to prevent your house becoming too dry in winter because of radiators or forced air heating.
Luckily, most skin conditions can be prevented or easily treated if caught early.
Talk to a member of your doctor or diabetes healthcare team, if you are concerned about your skin.