Which skin conditions are linked to type 2 diabetes?
An estimated one-third of people with diabetes experience skin conditions either related to or influenced by the condition.
People can use medication to resolve skin problems, but managing blood sugars is usually the best way to prevent and treat skin problems that relate to diabetes.
Type 2 diabetes and skin health
High blood sugar can lead to dehydration, dry skin, and inflammation.
When blood sugar levels are too high for too long, several changes take place in the body that affect skin health.
Blood sugar leaves the body through the urine. When there is too much blood sugar, a person will urinate more. This can result in dehydration and dry skin.
High blood sugar levels can also lead to inflammation. Over time, this can dull or overstimulates the immune response.
Nerve and blood vessel damage can also reduce circulation. Poor blood flow can alter the skin's structure, especially its collagen.
Without healthy collagen networks, the skin can become stiff and, in some cases, brittle. Collagen is also necessary for proper wound healing.
Most diabetes-related skin complications are harmless, but some can result in painful and persistent symptoms, and they may require medical attention.
The most effective treatment option for many diabetes-related skin conditions is effective blood sugar management. In severe cases, however, a doctor may prescribe oral steroids, medicated creams, or another treatment.
This article looks at some common skin conditions associated with type 2 diabetes.
Acanthosis nigricans features a darkened band of thickened, velvety skin, especially in the folds near the groin, back of the neck, or armpits.
It is not dangerous or contagious, but a doctor can advise about treatment. Managing blood glucose levels and body mass index (BMI) may help.
Psoriasis is a chronic autoimmune disease that causes itchy, scaly patches on the skin.
People with psoriasis often develop red patches on their skin that may be itchy and scaly.
Some people may also experience changes in their nails or scalp.
Some people with skin psoriasis may also develop psoriatic arthritis, which includes severe joint pain.
Treatment options for psoriasis include lifestyle changes, cortisone creams and ointments, managing blood sugar and body weight, and — in moderate to severe cases — oral or injectable biologic medications.
People with type 2 diabetes have a higher risk of developing psoriasis than those without diabetes.
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This is a connective tissue disorder. Symmetrical skin thickening affects the upper body, for example, the upper back and back of the neck.
In severe cases, it can make it harder for a person to move. Sclerederma is a rare condition that generally affects people with excess weight. The authors of one study note that it can affect people with diabetes who manage their blood sugar levels effectively as well as in those with poor glucose management.
It can also occur in people without diabetes, following a streptococcal infection.
Treatments include oral medications, such as cyclosporine, corticosteroids, and methotrexate, but research has not confirmed that any of these are effective. Some doctors may recommend light therapy.
Stiff joints and waxy skin
People with diabetes may develop tight, thick, waxy-looking skin on their skin, hands, and digits. This is due to circulatory problems.
It often starts on the hands, but it can spread to the arms and upper body. Less commonly, it can affect the knees, ankles, or elbows, and the skin may have an orange-peel appearance.
Joint stiffness can occur.
The best way for people with diabetes to prevent this complication is by maintaining their blood sugar levels. A doctor may recommend physical therapy.
Blisters, or diabetic bullae
Some people develop irregularly shaped blister-like sores that appear randomly across their feet and hands. The blisters are often large in size, painless, and occur alone or in patches.
The only real treatment option is good blood sugar management, although a doctor may aspirate large blisters under sterile conditions.
Those with bullae lesions should avoid breaking the blister, to prevent infection. They usually heal without scarring, but if complications develop, sometimes amputation may be necessary. This is a rare condition.
Shin spots or diabetic dermopathy
This condition involves circular, reddish, or light-brown patches that usually appear on the shins or other bony parts of the body. Patches are also usually indented and scaly.
The condition is caused by nerve and blood vessel damage, in particular small blood vessel changes.
As the condition impacts areas of the body with less protective muscle and fat, lesions may reflect an increased response to injury.
Lesions are harmless, and the person does not usually need treatment.
People with diabetes are prone to foot problems.
Sometimes, insignificant wounds can become open sores called diabetic ulcers. These can occur anywhere on the skin but are most common on the feet.
Diabetes can affect blood circulation and the nervous system. If a person has a wound on their foot due, for example, to ill-fitting shoes, the lack of sensation in the foot can mean that they do not notice the injury. In addition, low blood supply can make it harder for wounds to heal.
Without treatment, an ulcer can develop. If this becomes infected, there is a risk of tissue death, and the person may ultimately need an amputation.
It is essential for people with diabetes to:
- manage their blood sugar levels
- check their feet and other parts of the body regularly for wounds or lesions that may need attention
According to an article in the BMJ, almost 6 percent of people with diabetes will develop some type of foot disease, whether infection, ulceration, or tissue death. Between 0.3 and 1.5 percent of these people will need an amputation.
Find out more here about how diabetic ulcers can affect the feet.
A person with xanthelasma has scaly, yellow fat deposits on and near the eyelids. They may also appear on the neck, trunk, shoulders, and around the underarms.
Xanthelasma can result from high blood sugar and high levels of fat in the body, but they can occur in people without these factors.
In some cases, this is due to a genetic tendency to develop xanthelasma alongside high cholesterol. Conditions that increase the risk include diabetes, obesity, and pregnancy.
Xanthelasma does not pose a health risk, but it can affect a person's quality of life.
Some small studies have suggested that lipid-reducing medications may be effective.
Some people have tried esthetic treatments, such as laser therapy or a chemical peel. These may help, but there is no guaranteed way of removing xanthelasma.
Poor glucose management with diabetes can sometimes result in the appearance of crops of bumps with a reddish-brown to yellowish-orange color. These can be itchy.
Lesions can form anywhere on the body but most often appear on the thighs, buttocks, and in the crooks of the elbows and knees.
A severe case may signal an increased risk of pancreatitis. A person with severe symptoms should seek urgent medical attention.
Treatment for people with diabetes includes following a low-fat diet, losing weight, and managing blood sugar levels. After this, a doctor may recommend the use of statins or fibrates.
Skin tags are soft, skin-colored growths that hang from the skin. They affect around 25 percent of the general population, but they can also be a sign of high blood sugar levels in people with diabetes.
Studies have linked skin tags, also called acrochordons, with high or uncontrolled blood sugar levels.
Skin tags favor areas such as the eyelids, the underarms, the neck, under the breasts, and the folds of the groin.
Necrobiosis lipoidica diabeticorum (NLD)
NLD is a rare and chronic condition that causes a rash to form on the skin of a person with diabetes. Researchers estimate that it affects 0.3 percent of people with diabetes. More than half of these people are dependent on insulin.
Lesions usually begin as small, firm, raised bumps and progress to larger plaques of waxy, hard, depressed, yellow to reddish-brown skin.
Plaques are usually painless, and the surrounding skin appears pale and shiny in comparison.
Lesions often become waxy and develop a purple border over time. While harmless, NLD can cause complications, such as scarring. The skin is also more prone to infection. In around 15 percent of cases, ulceration can occur.
A worsening of symptoms may be a sign that the person's diabetes treatment plan needs adjusting.
Treatments for NLD can include topical and oral medications. The person should also protect the skin from further damage through injury, due to the risk of infection.
This conditions features small, firm, raised, reddish, or skin-colored bumps that spread outwards in a ring. Lesions often occur on the hands, fingers, and forearms. They can be isolated or numerous on the body. They usually appear symmetrically on the body.
The lesions are harmless and usually disappear without treatment, In bothersome or persistent cases, however, a doctor may prescribe a corticosteroid or isotretinoin drug. Light therapy may also help.
Diabetes and skin infections
People with type 2 diabetes tend to experience more frequent, severe bacterial and fungal infections than those without diabetes. They may also have more frequent, severe allergic reactions.
Ringworm is a fungal infection that can be more likely with type 2 diabetes.
These usually appear as inflamed, pus-filled, painful, red sores, usually due to an infection with the Staphyloccus bacteria.
Antibiotics and effective blood sugar management can usually prevent bacterial infections from becoming life-threatening.
After a few days, most bacterial sores will release pus and then begin to heal. A doctor may need to drain any sores that cannot drain on their own or that are painful or persistent.
Common bacterial infections for people with type 2 diabetes include:
- boils, which begin as sore spots and then become inflamed nodules up to 1 inch across
- styes, an infection of the eyelid gland
- nail infections
- infection of the hair follicles
- carbuncles, which are firm, tender lumps that group a collection of connected boils
These usually cause red rashes bordered by scaly skin and sometimes small blisters. Fungi require moisture to thrive, so infections tend to occur in warm, wet folds of skin, though they can occur anywhere on the body.
Common types include:
- yeast infections, such as thrush
- athlete's foot, which can appear as either scaly patches between toes, recurring blisters, or powdery scaling across the soles
- ringworm, a fungal infection that results in a ring-like rash
Treatment with antifungal medication can prevent prolonged or frequent infections.
The best way to reduce the risk, severity, and frequency of all diabetes-related skin conditions is to maintain healthy blood sugar levels.
Blood glucose tips
Lifestyle tips for achieving and maintaining healthy blood sugar levels include:
- following a healthful diet
- getting regular exercise
- maintaining a healthy weight
- following the treatment plan, including regular use of any medications the doctor recommends
Attention to personal care and hygiene can also help prevent these complications.
Skin care tips
Skin care tips include:
- avoiding long or hot baths and showers, saunas, and hot tubs
- choosing bath products that do not dry out or irritate the skin, such as fragrance-free soaps
- using mild shampoos, conditioners, and body washes
- keeping skin as clean and dry as possible
- using moisturizers to hydrate the skin
- using a humidifier and bathing less frequently when the weather is dry
- avoiding feminine hygiene sprays
- avoiding scratching or rubbing infections, rashes, and sores
- treating cuts immediately and monitoring their healing progress
- consulting a dermatologist about persistent skin problems
It is crucial for people with diabetes to check their feet for skin alterations, sores, and other changes daily.
Well-fitting, comfortable shoes can help improve foot circulation and prevent or lessen the impact of other conditions.
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