Skin rash and diabetes

Skin Problems Associated With Reduced Blood Supply to the Skin

  • Skin problems linked to atherosclerosis: Atherosclerosis is a serious health condition caused by the narrowing of blood vessels from a thickening of the vessel walls due to plaque buildup. While atherosclerosis most often is associated with blood vessels in or near the heart, it can affect blood vessels throughout the body, including those that supply blood to the skin. When the blood vessels supplying the skin become narrow, changes occur to the skin due to a lack of oxygen, such as hair loss, thinning and shiny skin especially on the shins, thickened and discolored toenails, and cold skin. Because blood carries the white blood cells that help fight infection, legs and feet affected by atherosclerosis heal more slowly when they are injured.
  • Necrobiosis lipoidica diabeticorum: Necrobiosis lipoidica diabeticorum (NLD) is thought to be caused by changes in the collagen and fat content underneath the skin. The overlaying skin area becomes thinned and reddened. Most lesions are found on the lower parts of the legs and can ulcerate if subjected to trauma. Lesions have fairly well defined borders between them and normal skin. Sometimes, NLD is itchy and painful. As long as the sores do not break open, treatment is not necessary. If the sores do break open, see your doctor for medical treatment.
  • Diabetic dermopathy: Also called shin spots, this skin condition develops as a result of changes to the blood vessels that supply the skin. Dermopathy appears as a shiny round or oval lesion of thin skin over the front lower parts of the lower legs. The patches do not hurt, although rarely they can be itchy or cause burning. Medical treatment generally is not necessary.
  • Digital sclerosis: Digital sclerosis is a health condition in which the skin on your toes, fingers, and hands become thick, waxy, and tight. Stiffness of the finger joints also may occur. The medical treatment is to bring your blood sugar level under control. Lotions and moisturizers may help soften the skin.
  • Eruptive xanthomatosis: This skin condition may occur when blood sugar levels are not well controlled and when triglycerides rise to extremely high levels. Severe resistance to insulin makes it difficult for the body to clear the fat from the blood. With extreme elevations in these blood fats people are at risk for pancreatitis, an inflammation of the pancreas. Eruptive xanthomas appear as firm, yellow, waxy pea-like bumps on the skin. The bumps — which are surrounded by red halos and are itchy — usually are found on the face and buttocks. They also can be seen on the back side of the arms and legs as well as in the creases of the extremities. Treatment for eruptive xanthomatosis consists of controlling the level of fats in your blood. The skin eruptions will resolve over a few weeks. Drugs that control different types of fats in the blood (lipid-lowering drugs) may also be needed.

Diabetes patients have increased risk of skin problems

Diabetes can affect all parts of your body, even your skin. According to the American Diabetes Association (ADA), as much as 33 percent of diabetes patients will have a skin disorder in their lifetimes. Fortunately, skin complications can be prevented.

For some people, skin problems are the first sign of diabetes. They may develop a skin problem that anyone can have, such as fungal or bacterial infections.

However, some skin problems occur mostly or only in people with diabetes.

Regardless of the cause of the condition, people with diabetes have an increased risk of developing skin problems. Through keeping a close eye on your body and working with your doctor, you can prevent diabetes-related skin complications. And if you catch a skin condition early, it can often be easily treated.

General Skin Complications

Bacterial Infections

There was a time when bacterial infections could be deadly, especially for people with diabetes. In this day and age, death is uncommon, mainly due to the creation of antibiotics and better ways for patients to control their blood sugar.

Still, bacterial infections are more common in people with diabetes than the rest of the population. Luckily, good skin care can lower the risk of getting an infection.

Examples of bacterial infections affecting diabetes patients include:

  • styes, or infections of eyelid glands
  • boils
  • folliculitis, or hair follicle infections
  • carbuncles, or deep tissue skin infections
  • infections around the nails

Bacterial infections are caused by organisms, or living creatures. The most common infection-causing organism is Staphylococcus – a bacteria also known as staph.

Affected skin is often hot, swollen, red and painful.

Fungal Infections

People with diabetes have an increased risk of fungal infection. In most cases, diabetes-related fungal infections are caused by Candida albicans – a yeast-like fungus that can cause itchy, red and moist rashes, small blisters and scaly skin.

Other fungal infections that commonly affect people with diabetes include:

  • athlete’s foot
  • jock itch
  • ringworm
  • vaginal infection

Talk to your doctor if you develop an infection. There are medications that can treat these conditions.

Diabetic Skin Conditions

Diabetic Dermopathy

Diabetes can cause changes to the small blood vessels that carry blood to the skin. These changes can lead to skin problems known as diabetic dermopathy.

Dermopathy often appears on the front of the legs as light brown or red, scaly patches. These patches do not hurt or itch. Dermopathy does not require treatment.

Necrobiosis Lipoidica Diabeticorum (NLD)

NLD is a rare complication. Like diabetic dermopathy, NLD may also be caused by changes to the blood vessels.

The spots caused by NLD may look like those of dermopathy, but they are bigger, deeper and fewer. At first, the spots may look dull and red. Over time, the spots can turn into a shiny scar with a violet rim.

In some cases, NLD can hurt and itch. The spots may even break open.

Unless your sores crack open, NLD does not require treatment. But if they do crack, go to your doctor for treatment.

Allergic Reactions

Allergic reactions can happen in response to eating certain foods or bug bites. They can also occur in response to diabetes medications, including insulin.

If you think you are having an allergic reaction to your diabetes drugs, tell your doctor immediately. In some cases, people having an allergic reaction need emergency treatment.

If you are taking insulin, keep a close on your injection spot. If you see rashes or bumps, you may be having an allergic reaction.

People with diabetes have an increased risk of atherosclerosis, a condition in which the arteries become narrowed or hardened. The narrowing of the arteries can cause changes to the skin.

Atherosclerosis can lead to hair loss, thinning and shiny skin, thickening and discoloration of the toenails and cold skin. Atherosclerosis also can make it harder for the legs and feet to heal after being injured.

Bullosis Diabeticorum (Diabetic Blisters)

In rare cases, diabetes can cause blisters that look like burn blisters. These blisters develop on the backs of fingers, hands, toes and feet. Sometimes the blisters occur on the legs and forearms.

While these blisters can be large, they do not hurt. The only way to get rid of diabetic blisters is to control your blood sugar levels. The blisters usually go away on their own in about three weeks.

Eruptive Xanthomatosis

Eruptive xanthomatosis also happens when diabetes is out of control. High levels of blood sugar and triglycerides (blood fats) lead to firm, yellow, pea-like bumps on the skin. Each bump is surrounded by a red halo and may itch. The bumps usually appear on the feet, arms, legs, buttocks and backs of the hands.

Treatment for eruptive xanthomatosis involves controlling blood sugar and lowering triglycerides in the blood.

Digital Sclerosis

Don’t be mistaken: “digital” does not mean this is some future, sci-fi, cyborg skin condition. Rather, the word refers to your fingers and toes.

In digital sclerosis, the skin on your toes, fingers and hands hardens, becoming thick, waxy and tight. You may feel stiffness in the joints of your fingers.

To treat digital sclerosis, you must control your blood sugar. Some lotions and moisturizers can soften your skin.

Scleroderma diabeticorum

This condition is similar to digital sclerosis; but instead of the hardening of the skin of the hands, scleroderma diabeticorum affects the skin on the neck and upper back.

Sclerdoma diabeticorum usually develops in people who are overweight.

To treat the condition, patients should lose weight and control their blood sugar. Some creams can soften the skin.

Disseminated Granuloma Annulare

People with disseminated granuloma annulare develop ring- or arc-shaped areas on the skin. These raised areas usually appear on body parts far from the trunk, such as fingers or ears. The rashes may be red, red-brown or the color of your skin.

If you develop rashes like this, go to your doctor for treatment. There are medications that can rid you of this complication.

Acanthosis Nigricans

In acanthosis nigricans, people develop tan or brown raised areas that usually appear on the sides of the neck, armpits and groin. In some cases, the raised areas appear on the hands, elbows and knees.

This condition most often affects overweight people. Thus, treatment involves losing weight. Some patients find that lotions or moisturizers help the skin look better.

How to Prevent Skin Complications

Skin complications of diabetes can be irritating and, at times, dangerous. Fortunately, most diabetes-related skin conditions are both preventable and treatable.

The biggest part of preventing skin complications is controlling your diabetes, which means controlling weight, blood sugar and blood fats. By following your doctor’s instructions about diet, exercise and medications, you can lower your risk of diabetes-related skin complications.

In addition, you can take care of your skin by avoiding too much sun and using lotions approved by your doctor.

Granuloma annulare

Types of granuloma annulare

Here are some of the main types of granuloma annulaire:

Localised granuloma annulare

The most common type, localised granuloma annulare, appears in just one or two areas, tends to affect children and young adults, and usually gets better on its own after a few months.

Pink, purple or skin-coloured patches typically appear on the fingers, backs of the hands, feet, ankles or elbows.

They form rings that grow slowly until they’re about 2.5-5cm (1-2 inches) across. As the rings get bigger, they become flatter and more purple in colour before eventually fading.

Credit:

ISM/SCIENCE PHOTO LIBRARY

In localised granuloma annulare, the top of the skin feels smooth and, unlike in other skin conditions, such as pityriasis versicolor, ringworm or eczema, it isn’t rough, dry or scaly.

The affected skin also feels firm as a result of inflammation in the middle layer of skin (dermis). There’s no change in the outermost layer of skin (epidermis).

Widespread granuloma annulare

More rarely, you can develop a widespread rash, known as generalised or disseminated granuloma annulare. It usually affects adults.

Large pink, purple or skin-coloured patches appear on a larger portion of the body, including the trunk, arms and legs.

Credit:

DR P. MARAZZI/SCIENCE PHOTO LIBRARY

The rash is sometimes made up of small raised spots that form symmetrical rings 10cm (4 inches) or more across. They’re often found in skin folds in the armpits and groin.

Under the skin

Granuloma annulare under the skin usually affects children. One or more firm, rubbery lumps develop under the skin.

They can range from 5mm-4cm (0.2-1.5 inches) in size.

They can appear on the shins, ankles, feet, buttocks, hands, scalp and eyelids.

The phrase “feeling comfortable in your own skin” is usually used figuratively to describe a level of self-confidence or self-acceptance. But when your skin itches, hurts, flakes, breaks out, changes color, or just doesn’t look or feel the way you’d like it to, the phrase can take on a new, very literal meaning.

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Diabetes can affect the skin in a number of ways that can make a person feel less than comfortable. In fact, as many as a third of people with diabetes will have a skin condition at some point in their lifetime. While some conditions may appear uniquely in people with diabetes, others are simply more common in people with diabetes. The good news is that a fair number of these conditions are treatable or can be prevented by maintaining blood glucose control and taking good daily care of your skin.

Dry, itchy diabetic skin

Dry skin can occur as a result of high blood glucose. When the blood glucose level is high, the body attempts to remove excess glucose from the blood by increasing urination. This loss of fluid from the body causes the skin to become dry. Dry skin can also be caused by neuropathy (damage to the nerves) by affecting the nerves that control the sweat glands. In these cases, neuropathy causes a decrease or absence of sweating that may lead to dry, cracked skin. Cold, dry air and bathing in hot water can aggravate dry skin.

— Learn More General Diabetes Information >>

Dryness commonly leads to other skin problems such as itching (and often scratching), cracking, and peeling. Any small breaks in the skin leave it more exposed to injury and infection. It is therefore important to keep skin well moisturized. The best way to moisturize is to apply lotion or cream right after showering and patting the skin dry. This will seal in droplets of water that are present on the skin from the shower. Skin that is severely dry may require application of heavy-duty emollients 2—3 times a day.

Itchy skin is usually related to dryness, but it can also be related to poor circulation, especially in the legs and feet. This is typically due to atherosclerosis, a disease in which fatty plaques are deposited in the arteries. Fungal infections, which can be more common when a person has high blood glucose, can also be very itchy.

Bacterial infections with diabetic skin

When blood glucose levels are high, a person with diabetes is more susceptible to infection. This is believed to be why there’s a higher incidence of certain bacterial infections among people with diabetes and why these infections tend to be more serious than in the general population. The following are some of the more common bacterial infections in people who have diabetes.

Impetigo and ecthyma

Impetigo is a common, contagious, superficial skin infection that starts out as fluid- or pus-filled blisters or pimples that rupture to form erosions on the skin. These erosions are then covered by crusts. Minor breaks in the skin may lead to an impetigo infection, or it may arise as the result of an existing skin problem, such as atopic dermatitis, contact dermatitis, psoriasis, ulcers, traumatic wounds, burns, or insect bites. This infection most often arises on the face, arms, legs, buttocks, hands, and skin folds such as the underarms and groin.

Ecthyma has many features similar to those of impetigo and can in fact result from untreated impetigo. The main difference is that ecthyma goes into the deeper layers of the skin, forming ulcerations, which then become covered with thick crusts. This condition most commonly occurs on the legs and sometimes the buttocks. Poor hygiene increases the risk of ecthyma.

Impetigo may improve on its own, or it may become chronic and widespread. The use of oral antibiotic medicine, coupled with topical antibiotics such as bacitracin, antibacterial soaps, and good hygiene, is typically sufficient to clear the infection within a week. Ecthyma is usually treated the same way but for a longer period of time; generally, antibiotics are taken for 10—14 days. Since lesions (areas of damaged tissue) are deeper in ecthyma, they usually take a longer time to close, and they may heal with some degree of scarring.

Folliculitis, furunculosis, and carbuncles

Folliculitis, furunculosis, and carbuncles are all infections that arise in the hair follicles. Sweat and other conditions that cause moisture on the skin (such as high temperatures and humid weather), the shaving of hairy regions such as the underarms and legs, and the blockage of hairy areas by clothing, bandages, or casts or by lying or sitting in one spot for a long period of time can all increase the risk of an infection in the hair follicles.

Folliculitis is inflammation of the hair follicle that is characterized by the formation of a pustule (a small pimple or blister containing pus) or a group of pustules. Furunculosis is distinguished by the development of furuncles – deep, red, hot, tender nodules – that may develop from the pustules found in folliculitis. The nodules usually enlarge, become painful, and rupture after several days, forming abscesses (swollen areas containing pus). Furuncles generally occur on the neck, face, underarms, and buttocks. A carbuncle is a larger, painful, more serious lesion with a deeper base, generally occurring at the nape of the neck, on the back, or on the thighs. The area is red, swollen, and covered in pustules. Fever and a feeling of illness may also occur with a carbuncle.

The chances of getting folliculitis may be lessened by using clean or new razors to shave, exposing areas of the skin that are typically covered, such as the back, to the air, and wearing loose, cool clothing. Lesions usually improve on their own, but they heal faster with the use of antibiotic washes and creams. Simple furunculosis is treated by the local application of antibiotic creams and warm, moist compresses, which relieve discomfort and promote drainage. A carbuncle or furuncle with a significant amount of redness or swelling or an associated fever should be treated with a systemic antibiotic (one that affects the entire body), since one of the risks of these lesions is an infection of the bloodstream. This can spread bacterial infection to many of the body’s organs, including the heart, brain, and kidneys.

When the lesions are large, painful, and fluctuant (they can be shifted and compressed), draining them via surgery is usually the best option. In these cases, the person should receive antibiotics until all evidence of inflammation has disappeared. After the lesion is drained, the area should be covered with a thin layer of antibiotic ointment and a sterile dressing.

Cellulitis and gangrene

Two of the more serious and complicated bacterial infections that occur in people with diabetes include cellulitis and infectious gangrene. Cellulitis is an infection that spreads through the deeper layers of the skin as well as the fat layer directly underneath the skin. People who develop cellulitis usually have an open wound that acts as an entry point for bacteria, although occasionally, the skin infection originates from a bacterial infection of the blood. Areas infected by cellulitis are typically red, warm, painful, and swollen. The lesions feel hard to the touch, and there is no clear line between skin that is infected and skin that isn’t infected. This condition usually affects the face and extremities, and sometimes it also occurs on the trunk. The legs are affected three times more often than the arms.

Cellulitis requires prompt medical care. It is important that the health-care provider take a culture to determine what organism is causing the infection so that the right antibiotic is used. Once oral or intravenous antibiotics are started, the average time for healing is 12 days, with a range of 5—25 days.

Infectious gangrene is a serious condition that usually develops on the hands or feet at the site of an injury such as a laceration, needle puncture, or surgical incision. It can also occur in surgical incisions on the abdomen. The condition generally begins as cellulitis, which is followed by fever and other generalized symptoms as the infection rapidly spreads. The area then becomes dusky blue in color, and blisters appear and rupture, forming areas of black skin.

Since the mortality rate (death rate) for infectious gangrene is high, it is important that it is diagnosed early and treated aggressively.

Fungal infections with diabetic skin

High blood glucose levels can also predispose people with diabetes to developing common fungal skin infections from organisms such as Tinea and Candida.

Fungal infections can occur just about anywhere, including the feet (Tinea pedis), the hands (Tinea manuum), the body (Tinea corporis), and the groin (Tinea cruris). Tinea pedis, or athlete’s foot, usually occurs in the web spaces between the toes or on the soles of the feet. Lesions are itchy and may develop vesicles (sacs filled with air or fluid) or may simply be red and scaly. It is usually contracted by walking barefoot on a contaminated floor. To help prevent athlete’s foot, it is always a good idea to wear slippers or shoes of some sort in public areas such as locker rooms. Tinea manuum is characterized by papules (small, raised pimples or swellings), vesicles, or scaling, typically on the dominant hand, and is associated with touching athlete’s foot lesions. Tinea corporis, or ringworm, presents as multiple red or pinkish circular lesions with a distinct, scaly border. In severe cases, the lesions may merge, forming large, discolored areas on the body. Tinea cruris, or jock itch, results in red to brownish, scaly, itchy lesions that cover the groin and sometimes extend to the pubic region and upper thighs.

Candidiasis of the skin tends to occur in folds of skin such as the underarms, groin, under the breasts, and between the buttocks. This condition begins with pustules on a red base that eventually result in softened, thickened areas of skin.

All of these superficial fungal infections are treated in more or less the same way. Applying antifungal creams two to three times daily for approximately two to four weeks should clear the infection. Keeping the affected areas dry, and using medicated powders in skin folds to reduce friction and moisture are also helpful measures. Infections that don’t respond to topical treatment may be treated with oral antifungal medicines.

Skin conditions associated with diabetes

The following skin conditions are strongly associated with having diabetes, but they can occur in people who don’t have diabetes as well.

This condition is characterized by the formation of velvety, brownish, thickened areas of skin in the groin, underarms, under the breasts, and in the creases of the neck. The affected skin may become leathery or warty or develop tiny skin tags. Acanthosis nigricans is common in people who are obese, but it may also be associated with certain forms of cancer as well as endocrine disorders such as polycystic ovarian syndrome (PCOS), acromegaly, Cushing syndrome, and diabetes.

There is no cure for this condition, but it may improve with weight loss, topical bleaches, or a class of drugs known as keratolytics.

Vitiligo is a skin disorder that causes white spots or large areas of depigmentation to occur on various areas of the body. About 30% of people with vitiligo have a family history of the condition, and it is more common in people with Type 1 diabetes than Type 2 diabetes. Vitiligo progresses slowly over the years, commonly affecting the backs of the hands, the face, and body folds such as the underarms and groin.

Treatment of vitiligo is necessary only in people who have severe cases or who are considerably distressed by the condition. Treatment involves the use of steroids or chemical agents called psoralens that are either placed directly on the skin or taken orally. The most popular treatment, known as PUVA, uses oral psoralens in combination with phototherapy sessions, in which the person is exposed to ultraviolet light, specifically ultraviolet A.

A common skin disorder of unknown cause, granuloma annulare manifests as skin-colored or pinkish groups of bumps, or papules, that may be arranged in rings. There are several subtypes of granuloma annulare; the one associated with diabetes is called disseminated, or generalized, granuloma annulare, in which lesions are widespread over the body. The use of steroid creams or ointments or steroid injections is sometimes used to treat lesions. Most, however, disappear on their own within two years.

The following skin conditions occur almost exclusively in people who have diabetes.

This common skin condition is characterized by depressed, irregularly round or oval, light brown, shallow lesions. Lesions may vary in number from few to many and are usually found on both legs but are not symmetrically distributed. Because these lesions do not itch, hurt, or open up, they are often overlooked and not reported to the health-care provider.

This is an uncommon condition in which blisters occur on the hands and feet and sometimes also the legs and forearms. The blisters are unrelated to trauma or infection; they develop spontaneously and may become quite large. However, they are usually not painful and typically heal without scarring in several weeks.

Foot ulcers

Foot ulcers are a serious problem that can ultimately lead to amputation if left untreated. Each year, about 2% to 3% of people with diabetes develop a foot ulcer. Approximately 15% of people with diabetes develop a foot ulcer at some point in their lifetime.

Foot ulcers are erosions on the skin of the feet. Some affect just the outermost layers of skin, while others extend to deeper tissues. Ulcers often begin as a result of minor trauma, such as irritation from ill-fitting shoes that goes unnoticed or untreated. The most common locations for ulcers to develop are the weight-bearing areas of the foot such as the heel and the ball of the foot and sites subject to pressure such as the toes or ankles.

A number of factors make people with diabetes more likely to develop foot ulcers than those without diabetes. Neuropathy is one risk factor. Almost all people with diabetes who develop typical foot ulcers have neuropathy that affects their motor, sensory, or autonomic nerves. Neuropathy in the motor nerves causes weakness, thinning, and limitation in the movement of certain muscles in the foot, leading to deformities in the normal foot shape such as atypically high arches, claw toes (all toes except the big toe bend toward the floor) and hammer toes (the longest toe bends toward the floor at the middle toe joint). Neuropathy of the sensory nerves results in loss of protective sensation to pain, pressure, and heat. People with sensory neuropathy may therefore not be aware of cuts, abrasions, and calluses that can lead to ulcers. Depending on the amount of sensory neuropathy, people may even be unaware of major traumas to their feet, such as occur from stepping on pins, glass, and other sharp objects. Neuropathy of the autonomic nerves can lead to warm, excessively dry feet that are prone to skin damage.

Peripheral vascular disease is another factor that can contribute to the formation of foot ulcers in people with diabetes. Because of the decreased blood circulation to the feet in this condition, there is an impaired delivery of oxygen, nutrients, and antibiotics. Therefore, wounds tend not to heal well and to become infected.
Foot ulcers warrant immediate attention and treatment. The physician will need to determine how deep and infected the ulcer is. He may take an x-ray of the foot to check whether infection has spread to the bone. Treatment for a foot ulcer may include oral or intravenous antibiotics to control the infection, as well as dressings and salves with lubricating, protective, antibiotic, or cleansing properties. Taking care of the ulcer and following up with health-care providers is very important for preventing complications that could eventually lead to an amputation.

This condition occurs in about 0.3% of people with diabetes and is three times more common in women than in men. Lesions tend to form on the fronts and sides of the lower legs, although they may also occur on the face, arms, and trunk. The typical lesion begins as a tiny, dusky red, elevated nodule with a defined border. It gradually enlarges, becoming irregular in shape. It may then become depressed and turn a brownish-yellow color, except for the border, which remains red. Affected areas may lack sensation because of the destruction of some nerves and nerve endings.

The course of this condition is usually chronic and recurrent. Although topical steroids may halt progression of active lesions, it is very difficult to completely cure the affected areas. Untreated lesions can readily deteriorate to form shallow, painful ulcers. Unfortunately, not even the normalization of blood glucose levels is sufficient to control this skin condition in many cases.

Digital sclerosis and scleredema audoltorum

Digital sclerosis is a condition in which the skin on the hands becomes thickened and waxy and may develop multiple, pebble-like growths. Scleredema audoltorum is a similar condition that affects the back and sides of the neck, with the possibility of painless swelling spreading to the face, shoulders, and upper torso.

Although there is no effective treatment for these conditions, they generally resolve on their own within six months to two years.

Saving your skin

To protect your skin and help prevent skin ailments from developing, observe good hygiene. Bathe regularly and wash your hands often. Keep areas of the skin that are susceptible to infections, such as the underarms, groin, area under the breasts, neck, web spaces of the feet and hands, and inner thighs clean and dry. If necessary, use antichafing powders or creams and choose proper clothing that allows air to circulate. After bathing, dry these areas well to prevent infections from beginning. People who live in hot, humid areas should change their clothing once it becomes wet from perspiration.

Be sure to use mild or hypoallergenic varieties of products that come in contact with the skin, such as soaps, lotions, washes, and creams. Products with additives such as fragrances or coloring can irritate the skin or cause an allergic reaction.

Diabetes rashes

Also keep an eye out for skin reactions that arise as a result of allergies to medicines. Reactions to oral drugs may take the form of itching, rashes, or wheals, while reactions to insulin may appear as bumps, rashes, or depressions in the areas where insulin is injected. If you suspect you are allergic to one of your diabetes drugs, inform your health-care provider.

Wounds should be treated promptly. Since people with diabetes may not heal as well as others, it is important to give immediate attention even to cuts and wounds that seem minor. Injuries to the skin should be kept covered and inspected on a regular basis to make sure they are not worsening. The hands and feet should be inspected daily for the presence of cuts or scrapes, since these parts of the body may have decreased sensation due to neuropathy, and wounds may therefore go unnoticed. Dryness and itching can be self-treated, but more serious conditions should be brought to the attention of a doctor.

Preventing foot ulcers

Proper foot care is a vital part of preventing minor wounds from developing into ulcers. This means the feet should be inspected daily for cuts, sores, or other forms of irritation. The toenails should be cut straight across. (If a person cannot see or reach his feet, a health-care provider should cut his toenails.) The feet should be washed daily in warm water and carefully dried, especially between the toes. A moisturizing lotion should then be applied, but not between the toes.

A health-care provider should examine the feet at least once a year. People with risk factors for developing a foot ulcer, such as neuropathy, foot deformities, calluses, or a history of foot ulcers, should have their feet inspected by a doctor more often, preferably every one to six months. If a person notices a blister, cut, scratch, sore or other form of irritation, he should be sure to notify his health-care provider immediately.

People with diabetes should avoid walking barefoot, even when indoors. Socks or stockings should also be worn to reduce friction between the foot and the shoe. If possible, choose seamless socks and stockings. Socks with lumpy seams can be worn inside out to prevent irritation to the skin.

Wearing shoes that fit is very important, since ill-fitting footwear is a major cause of foot ulcers. People who have not lost the protective sensation in their feet can choose off-the-shelf shoes. Shoes should have some room, preferably 1/2—5/8 inch, between the front of the shoe and the longest toe. The width of the shoe should accommodate the ball of the foot, and the toes should not be cramped. Selecting a store with a certified pedorthist on staff is a good idea, since this person will know the subtle differences between various styles. It is best to select shoes toward the end of the day, when feet are at their largest.

People who have lost the protective sensation in their feet due to neuropathy or those who have peripheral vascular disease, foot deformities, calluses, ulcers, or other special circumstances should discuss getting customized shoes with their physician.

The skin you’re in

A large part of keeping your skin healthy involves maintaining practices that are good for your whole body, such as eating a balanced diet, drinking plenty of water, managing stress, and controlling your blood glucose level. Good diabetes management is especially important, since many skin conditions are related to complications resulting from high blood glucose. By sticking with healthy habits and keeping an eye on your skin, you can avoid many common ailments and be happy with the skin you’re in.

10 Diabetes Skin Problems You Should Know

Do you have diabetes? Diabetes is the fastest growing long-term (chronic) disease, affecting millions of people across the globe. In the United States, more than 25 million people suffer with diabetes. About 75 percent of them have type 2 diabetes, linked to obesity or being overweight. Researchers believe that the diabetes epidemic will escalate, and predict that in 2050, one in three Americans will have diabetes.

About a third of people with diabetes will develop skin problems such as skin sores or a leg rash. In fact, according to the American Diabetes Association (ADA), some skin problems can be warning signs of diabetes in those who are undiagnosed. The good news is that most skin problems with diabetes can be prevented or treated easily if they’re caught early.

Keeping proper control of your blood sugar (glucose) can prevent diabetes skin problems and many other diabetes symptoms from happening in the first place.

Many diabetes skin problems can happen to healthy people, but people with diabetes have a much higher risk. Diabetes skin problems include:

  • Bacterial infections
  • Diabetes rash
  • Diabetic blisters
  • Diabetic dermopathy
  • Eruptive xanthomatosis
  • Fungal infections
  • Necrobiosis lipoidica diabeticorum
  • Skin itching

Controlling your blood glucose is the first step in preventing and treating diabetes skin problems. When diabetes affects your skin, causing skin sores or diabetes rash, it is a sign your blood sugar levels are too high.

If you notice any skin problems, it is time to talk to your doctor. Get tested for diabetes if you have yet to be diagnosed. Work with your doctor and diabetes nurse educator to learn how to control your diabetes with diet, exercise, and medications, if needed.

Additionally, see a dermatologist about any diabetes skin problems. Some diabetes skin problems don’t look too serious but could lead to future complications if left untreated.

“For the most part, control of diabetes can help with related skin issues,” says Justin Ko, MD, the medical director and service chief of medical dermatology at Stanford Health Care in Redwood City, California. “I’m always adamant that my diabetic patients take aggressive care of their skin and health in general. For the skin, moisturization, checking feet and legs daily for any blisters, sores, and skin breaks (especially between the toes), and nail care is extremely important. Nail and foot fungus can lead to skin cracks and breaks, allowing bacteria to enter and cause infection.”

Diabetics have cause to pause over spotty rashes

I’m comfortable in my own skin, no matter how far it has stretched.

— Dolly Parton

Every now and then I notice that I’ll be itching and itching and itching. I tend to scratch away until I finally notice I’ve left red spots on my skin that usually turn into little scabs or red areas.

I tend to itch on my hands, legs and, as of recently, my wrists. Before I was diagnosed as a Type 2 diabetic I don’t think I ever really paid attention, but now that I’ve had the disease awhile and am familiar with the symptoms and signs, I wish I would have seen it coming.

According to information I found on the website of the American Academy of Dermatology (aad.org), there are about 12 warning signs of diabetes that can appear on the skin.

1. Necrobiosis lipidica is a medical condition that often begins as small, raised, solid bumps that start out looking like pimples. As it progresses, the bumps turn into patches of swollen and hard skin. The surrounding skin has a shiny, porcelain-like appearance; you can see blood vessels, and the skin is itchy and painful. The disease goes through cycles where it is active, inactive and then active again.

2. Acanthosis nigricans can be a sign of prediabetes. A dark patch or band of velvety skin on the back of the neck, armpit, groin or elsewhere could mean that there is too much insulin in our blood.

3. Digital sclerosis is a medical condition that develops on the fingers, toes or both. On the backs of the hands you may notice tight, waxy skin, and the fingers can become stiff and difficult to move. Hard, thick or swollen-looking skin can spread to the arms, the upper back, shoulders and neck, and possibly onto the face.

This often develops in people who have complications due to diabetes or whose diabetes is difficult to treat.

4. While it’s not very common, diabetics could see blisters on the hands, feet, legs or forearms. Unlike a burn, these blisters are not painful. The medical name is bullosis diabetricorum.

5. Skin infections can be hot, swollen and painful. These can be an itchy rash, tiny blisters, dry scaly skin or a white discharge.

6. Diabetic ulcers are open wounds that can develop if you’ve had uncontrolled diabetes for a long time. Poor circulation and nerve damage can make it hard for your body to heal wounds, especially on the feet.

7. Diabetic dermopathy are spots that create barely noticeable depressions in the skin. They typically form on the shins, but in rare cases could show up on the arms, thighs, trunk or other body areas. They are often mistaken for age spots, but while age spots fade, diabetic dermopathy can stay on the skin indefinitely.

8. Eruptive xanthamatosis are small yellowish bumps on the buttocks, thighs, crooks of the elbows or backs of the knees. They are usually tender and itchy. This condition appears when you have uncontrolled diabetes.

9. Granuloma annulare, rings of bumps, are associated with diabetes, but most people with this condition do not have diabetes.

10. Diabetics are more likely to have dry skin caused by high blood sugar. Infections and poor circulation can contribute to the problem. Better glucose control can help, but if it won’t go away, a dermatologist may be able to help.

11. Xanthelasma is a condition that develops due to high fat levels in the blood or because of poorly controlled diabetes. It consists of yellowish scaly patches that develop on and around the eyelids. Better glucose control can clear it up.

12. Skin tags are growths that hang from a thin stalk, and they are rather unattractive. They are common in older people, but numerous tags can be a sign that there is too much insulin in the blood or that you have Type 2.

The takeaway in all this is that diabetes can cause skin problems. Most are harmless, but even a minor one can become serious in people with diabetes. When in doubt check it out.

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Style on 10/08/2018

Rosacea-like facial rash related to metformin administration in a young woman

On December 2012, a 29-year-old woman presented to our observation for facial cutaneous rash that had appeared about 10 months earlier. She had only a past history of allergy to penicillin. Medical history was unremarkable until February 2012, when was made her a diagnosis of impaired glucose tolerance (IGT), insulin-resistance (evaluated by hyperinsulinemic euglycemic clamp) and subclinical hypothyroidism. For this reasons after we obtained the written informed consent, she started metformin (500 mg/12 h), used off-label, plus levothyroxine (50 μg/die). Two days after the beginning of this treatment she noticed intense pruritus and burning in the center of the face. In about 1 month her skin rash worsened in severity and the eruption involved the whole face (except for orbicularis oculi), in particular malar areas and forehead like a butterfly with papules and teleangectasies (see Figure 1). During this time she was not taking any pharmacological or herbal products except for metformin and levothyroxine. Firstly a dermatologist diagnosed a rosacea and prescribed both minocycline and metronidazole for 1 month, without any benefit. The persistence of symptoms induced a new clinical examination and another dermatologist hypothesized a probable subacute cutaneous lupus like-syndrome and treated with cetirizine, vitamin E, total-block sunscreens and lincomicine, without clinical effects. A new dermatologist diagnosed a probable toxic mixoedema thyroid-based disease, so deflazacort (30 mg/day for 1 month) was started with a transient moderate improvement of symptoms that reappeared when the therapy was finished.

Figure 1

Skin rash during metformin treatment.

On December 02nd 2012, the patient forgot to take the metformin treatment and she noted a moderate improvement of pruritus, and due to this empiric experience she went to our observation. On admission clinical examination revealed the presence of erythema with papular eruption involving cheeks, glabella, perioral zone, until scalp and mandibular area. There was no involvement of neck, ears, shoulders, groin, thighs or knees. She was overweight (Body Mass Index = 28 kg/m2) and cardiopulmonary, abdominal, ophthalmologic systems were unremarkable. Laboratory findings (i.e. blood cells count, immunoglobulins, C3, C4, C-reactive protein, glucose, insulin, serum protein electrophoresis and urinalysis) were in normal range. Both an extensive autoimmune tests (i.e. antinuclear antineutrophil cytoplasmic, anti-Ro/SSA antibodies, anti double stranded-DNA antibodies cryoglobulins, rheumatoid factor) and infective serological screening (i.e. hepatitis B, C, helicobacter pylori) were negative too. A nailfold capillaroscopy showed a pattern of regular disposition of the capillary loops along with the nailbed.

In order to evaluate the association between metformin and facial rash, we re-administered metformin with an impairment of skin manifestation. According to the Naranjo probability scale , we documented a probable association (Naranjo Score 7/13) between facial rush and metformin administration. Metformin was stopped with a progressive remission of exanthema in about 1 month (Figures 2 and 3).

Figure 2

Clinical evaluation 7 days after the dismission of metformin. It is possible to see a decreased manifestation of facial skin rash, considering both papular rash and hyperemia.

Figure 3

Clinical evaluation performed 1 month after the dismission of metformin. It is possible to evaluate a complete remission of facial skin rash.

Type 2 diabetes mellitus is a serious and costly disease and the Diabetes Prevention Program Research Group demonstrated that treatment with metformin is able to reduce the incidence of diabetes in subjects with such risk factors including impaired glucose tolerance and/or to reduce the insulin-resistance . In agreement with these studies, after we advise the patient regarding the treatment and obtained the written informed consent, an off-label treatment with metformin was started. Metformin has been used clinically for many years with good safety profile, and rarely induces skin ADRs . However, Salem and coworkers , described a leukocytosis vasculitis with purpuric necrotizing eruption in lower legs in a young woman during metformin’s treatment.

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