Solving Diabetes Skin Problems
Common Health Issues

Solving Diabetes Skin Problems

People with diabetes experience a wide array of skin problems. The exact cause of many of these conditions remains unknown, and it is not even clear whether diabetes is to blame. However, it is known that many skin conditions are more common in people with diabetes. Some skin problems seem to be associated with metabolic imbalances. Others are caused by infection. And some skin problems may be triggered by your diabetes medications. Fortunately, most of the skin problems associated with diabetes are not harmful, but they can be unsightly and uncomfortable. On the other hand, other conditions such as infections, can be life-threatening. It is important not only to learn how to manage the nonthreatening conditions and make your life more comfortable, but also to recognize the warning signs of those conditions that could be more serious.

DIABETES SKIN PROBLEMS

 

DIGITAL SCLEROSIS

If you have type 1 diabetes, you may have a tendency to develop stiffness in the small and large joints. More than a third of people with joint problems also develop thick, waxy skin. This combination of symptoms is called digital sclerosis. The exact cause of this condition, which affects up to 30% of people with type 1 diabetes is not known. Scientists do know that glucose molecules attach to collagen, the underlying connective tissue of the skin. This may disrupt the collagen, which provides elasticity to your skin and structure to your tendons and ligaments. When your collagen structure is disrupted, your joints don’t work right, and your skin takes on a thick and waxy appearance. 

Fortunately, the condition is not usually painful, but it can limit mobility. Patients who have this kind of joint immobility also seem to experience more microvascular problems.

 

DIGITAL SCLEROSIS SYMPTOMS

Symptoms include a thickening of your skin, which takes on a waxy feel. You may find it difficult to move your joints because they are still, but not painful. If you try to place your hand flat on a tabletop or press the palms of your hands together in a praying position, you may find it difficult to straighten your fingers completely.

What You Should Do

There is no known treatment for this condition. However, some studies have shown that maintaining good blood glucose control can improve and even reverse the symptoms.

DIGITAL SCLEROSIS PREVENTION

The best way to prevent digital sclerosis is by maintaining good control of your blood glucose levels.

 

DUPUYTREN’S CONTRACTURE

For unknown reasons, some people with diabetes develop a thickening and shrinkage of the tissue that lies under the skin on the palm of their hand. The tendons seem to contract and their fingers may become permanently bent.

 

DUPUYTREN’S CONTRACTURE SYMPTOMS

Signs of Dupuytren’s contracture include a thickening of the tissue on the palm of your hand. Eventually, you may be unable to bend your pinkie and ring fingers. One or both hands may be affected. There is no pain associated with the condition, but it can render your hand useless. Sometimes you may also notice thickened skin pads on the balls of your feet. 

 What You Should Do

The only known treatment of Dupuytren’s contracture is surgery. The earlier it is detected, the greater the success of the surgery. If you notice any of the symptoms of the condition, tell your doctor as soon as possible.

YELLOW SKIN

Several different conditions can make your skin or fingernails look yellow. Some of these conditions, although not unique to people with diabetes, are fairly common in people with diabetes. For example, both carotenoderma and xanthochroma seem to occur in people with diabetes and in those who eat a lot of yellow and orange vegetables. Yellow nails can be caused by fungal infection or peripheral vascular disease, but for many people with this symptom, there is no apparent cause. Fortunately, none of these conditions is painful or life-threatening.

 

YELLOW SKIN SYMPTOMS

If you have carotenoderma, you may notice that your skin has a slight yellowish color. This is due to deposits of carotene, found in yellow and orange vegetables, in the skin. Carotenoderma can be distinguished from jaundice in that there is no yellowing in the whiteness of the eyes. Xanthochromia is a fairly rare condition characterized by yellowing of the skin on the soles of the feet. Some people with diabetes have yellow fingernails and toenails. The first sign can be a brown or yellow color on the nail. Later, all the nails can turn bright yellow.

What You Should Do

If you notice a yellow tinge to your skin, look in the mirror at the whites of your eyes. If they are clear, you probably have nothing to worry about. You may have carotenoderma, which is a harmless condition. However, if you notice any yellowing in the whites of your eyes, you could have jaundice due to liver or gallbladder disease. If this is the case, call your doctor right away. 

 

If you notice that only the soles of your feet are yellow, you could have xanthchromia. This is thought to be caused by the liver’s reduced ability to convert carotene in certain foods to vitamin A. the condition is not harmful, but you might want to talk to your doctor or dietitian about whether or not vitamin supplements are in order.

 

If your toenails and fingernails are yellow, talk to your doctor. Half of all cases of yellow nails have no known cause. However, yellow nails could signal a fungal infection that should be treated as soon as possible to avoid further infection. Your doctor will probably prescribe a topical or oral antifungal agent. Yellow nails could also be a sign of peripheral vascular disease. This is a serious complication of diabetes that can sometimes lead to foot disease and amputation. Talk to your doctor about it, especially if you notice any leg pain.

DIABETIC DERMOPATHY

Diabetic dermopathy is characterized by the appearance of small, round, colored spots on the lower part of your legs. This condition is more common in men with diabetes, although people without diabetes sometimes develop it. Seventy percent of all men with diabetes over the age of 60 develop diabetic dermopathy.

DIABETIC DERMOPATHY SYMPTOMS

If you have diabetic dermopathy, you may first notice small pink spots on your shin or lower leg that eventually turn brown. The lesions usually range in size from 0.5 to 2 cm. Sometimes the skin can become scaly. The cause is not known, but it seems to be more common in those with neuropathy. The spots often disappear spontaneously, but new spots tend to develop nearby.

What You Should Do

Diabetic dermopathy does not produce any symptoms other than the appearance of the spots themselves and require no treatment. If they do produce any kind of discomfort, talk to your doctor.

 

NECROBIOSIS LIPOIDICA DIABETICORUM

Necrobiosis lipoidica diabeticorum is another skin condition that affects the shins and lower legs. It is associated with a breakdown of collagen under the skin. Necrobiosis lipoidica diabeticorum is a fairly rare condition that usually affects people with type 1 diabetes. It can occur in young adults and is more common in women than in men. Sometimes the symptoms may appear before diabetes has even been diagnosed.

 

NECROBIOSIS LIPOIDICA DIABETICORUM SYMPTOMS

Early signs of Necrobiosis lipoidica diabeticorum are the appearance of red bumps on the shin. These lesions can also appear on the scalp, face, arms, and body, but they are more common on the lower leg. Sometimes the bumps are reddish brown to purple. They eventually grow together and enlarge. These larger lesions usually develop a thin yellow center and the skin takes on a shiny, almost transparent, appearance. Often you can see small blood vessels under the surface of the skin. These lesions frequently form ulcers, or open sores.

What You Should Do

Tell your doctor if you notice any unusual bumps or lesions. Necrobiosis lipoidica diabeticorum often goes away by itself in 10% to 20% of the cases. If you develop an ulceration, or open sore, contact your doctor right away. You will want to take steps to make sure the sore does not become infected. Any infection can have serious consequences.

There is no effective treatment for Necrobiosis lipoidica diabeticorum. Your doctor may suggest that you apply a steroid cream and cover the area with a light bandage. Steroid cream and injected steroids may prevent new areas from appearing. Some experimental treatments, including low doses of aspirin and the antiplatelet drug dipyridamole, have been encouraging.

You may want a cosmetic treatment to cover up these lesions. Some women have found that a green-based waterproof cosmetic cream may cover areas of discoloration. Consult with an experienced cosmetologist to help you select the appropriate cosmetic treatment. Before applying any topical creams or cosmetics, check with your doctor first to make sure it will not further aggravate your condition.

 

GRANULOMA ANNULARE

Granuloma annulare is an inflammatory disorder of the skin. It most commonly affects the hands or feet of children and young adults with type 1 diabetes, but it can spread across the arms, neck and trunk. The cause of granuloma annulare is unknown.

GRANULOMA ANNULARE SYMPTOMS

Granuloma annulare first appears as flesh-colored, red or red-brown bumps. These begin to grow together to form ring-shaped patched. You may even mistake it for ringworm. The skin in the middle of these rings is flat and may be red or flesh-colored. It usually appears on the hands and feet. If it spreads across the trunk of the body, it is called generalized granuloma annulare. There are no other symptoms other than the appearance of the spots themselves.

What You Should Do

Granuloma annulare usually goes away on its own. In the meantime, it can be treated with injected steroids, steroid creams or niacinamide.

 

SCLEREDEMA

This condition can be little confusing. It sounds like a more serious autoimmune disease, scleroderma, but it is quite different. Scleredema can occur in people with diabetes, usually men who are overweight. It can also occur in people without diabetes, usually children, following a streptococcal or viral infection.

 

SCLEREDEMA SYMPTOMS

Scleredema is characterized by the appearance of a patchy thickening of the skin, usually on the back, shoulders and neck. If you have Scleredema, your skin almost looks like the skin of an orange. Less often, it affects the face, upper arms, abdomen, lower back and tongue. In people with diabetes, the condition is usually painless, although you may have a decreased sensitivity to pain or touch in the affected areas. You may also notice a redness associated with it.

What You Should Do

When Scleredema occurs in children following an infection, it usually goes away on its own. But if you have diabetes, Scleredema is less likely to disappear spontaneously. Unfortunately, there is no known treatment for this condition

 

BULLOSIS DIABETICORUM

Bullosis diabeticorum is a blister that develops for no apparent reason in people with diabetes. The condition is rare and tends to occur in people who have had diabetes for a long time, especially those with neuropathy.

 

BULLOSIS DIABETICORUM SYMPTOMS

If you have Bullosis diabeticorum, you may notice blisters on the skin of your forearms, fingers, feet, and toes that contain clear fluid. The blisters range in size from a few millimeters to a few centimeters and appear on normal (uninjured) skin.

 

What You Should Do

Bullosis diabeticorum heals on its own with no treatment and usually goes away in 2 to 4 week. Do not attempt to break the blisters. Let them dry up on their own. As the blisters heal, they may darken or even turn black. If you do break the blister, tell your doctor and be on the lookout for signs of infection.

 

XANTHOMAS

If you have poor control of your blood glucose and triglyceride levels, you may develop bumps on the skin called xanthomas. There are several types of xanthomas, including eruptive xanthomas, which usually appear suddenly, and a type of xanthoma found on the eyelid, called a xanthelasma. Xanthelasmas are common in women than men. The bumps are frequently filled with lipids, or fats. They usually don’t cause any trouble on their own, but they could serve as a warning sign that your fat and cholesterol levels are too high.

 

XANTHOMAS SYMPTOMS

Eruptive xanthomas are small red bumps with yellow heads, about 4 to 6 mm in diameter that appear suddenly and are not easily broken. They usually appear on the elbows, knees, buttocks or at the site of an injury. Xanthelasmas first appear as small yellow-orange bumps on the eyelid, then thicken and can eventually cover the entire eyelid.

What You Should Do

Xanthomas rarely break or cause ulcers and do not lead to any more serious complications. If they occur, talk to your doctor and try to control your blood glucose, cholesterol and triglyceride levels. This may require a visit to your dietitian. They may disappear if you lower your blood cholesterol and triglyceride levels. More importantly, they serve as an indicator that you need to control your fat intake and blood glucose levels. Failure to do so could lead to more serious complications, such as cardiovascular disease

 

ACANTHUS NIGRICANS

Acanthus nigiricans is a skin discoloration often found in people with type 2 diabetes who are obese and have insulin resistance.

ACANTHUS NIGRICANS SYMPTOMS

The only symptom of acanthus nigricans is a darkening of the skin from velvet tan to dark brown on the sides of the neck, sides of the body, armpits, and groin. It sometimes also occurs in the joints of the hand, fingers, elbows and knees.

What You Should Do

Acanthus nigricans itself is not harmful, but it can be a sign of high insulin resistance. Usually losing weight and bringing your blood glucose levels under control will improve the condition. If you want to improve the way it looks, you can try topical agents such as urea and retinoic acid but check with your doctor first. Retinoic acid can cause birth defects, so do not use it without the advice of your doctor if you are pregnant.

 

VITILIGO

Vitiligo is a skin condition found more commonly in people with type 1 diabetes. Its exact cause is not known, but some evidence suggest that it may be caused by an immune disorder.

VITILIGO SYMPTOMS

Vitiligo appears as patches of discolored skin. Usually these patches have lost pigment and have no color. If you are exposed to sunlight, these areas will not tan. It usually affects the trunk of the body but can also be found near the nostrils, eyes, mouth and other openings

What You Should Do

Talk to your doctor if you notice any sort of pigment discoloration. Certain fungal infections can have a similar appearance. There is no treatment for vitiligo, but it can be covered with makeup

 

PRURITUS

Pruritus is a general name for itchy skin. Itchy skin in someone with diabetes can have several causes. It can be due to the irritation of your sensory nerve endings, for example. Itchy skin can also be a symptom of kidney complications, which are common in people with diabetes. High levels of urea in the blood, a condition known as uremia, can also cause itching. Shingles, a condition caused by the same virus that causes chicken pox, can also cause intense itching. Shingles is common in people with diabetes.

PRURITUS SYMPTOMS

The primary symptom of pruritus is itchy skin. When it affects the feet and legs it can become very uncomfortable and difficult to control. This may make you want to scratch a great deal. The itchiness associated with shingles can be especially painful.

 

What You Should Do

If you have painful itching and find it difficult to resist the urge to scratch, talk to your doctor. Excessive scratching can damage the skin, and depending on the condition that is causing it, can lead to ulcer formation. Your doctor can prescribe a steroid cream that may provide some relief. If your condition is due to kidney problem, maintaining good control of blood glucose levels could improve your condition. Often the itchiness may go away on its own

 

NECROLYTIC MIGRATORY ERYTHEMA

A rather uncommon skin condition can be caused by a tumor of the pancreas. This type of tumor, called a glucagonoma, can cause a metabolic imbalance that triggers a skin rash called necrolytic migratory erythema.

 

NECROLYTIC MIGRATORY ERYTHEMA SYMPTOMS

Necrolytic migratory erythema appears as a bright red to brownish red skin rash on the abdomen, buttocks, hands, feet or legs. If you have a tumor, you will probably notice the rash well before the tumor is discovered. If you have necrolytic migratory erythema, you might also have anemia and diarrhea. Your tongue may be smooth and bright red, and you may experience weight loss.

What You Should Do

If you notice any of these symptoms, contact your doctor right away. If you are found to have glucagonoma, the tumor should be removed promptly. Usually the symptoms disappear immediately. Without tumor removal, the rash resists treatment, although the symptoms may come and go.

 

 

Sources and References

The Diabetes Problem Solver—Quick Answers to Your Questions About Treatment and Self-Care by Nancy Touchette

Pathophysiology and burden of infection in patients with diabetes mellitus and peripheral vascular disease: focus on skin and soft-tissue infections  by M Dryden, J Li et al

Diabetes and acute bacterial skin and skin structure infections by Marco Falcone, Stefano Del Prato et al

author

Rich Health Editorial Team

Health Research

Rich Health Editorial Team is made up of medical practitioners and experienced writers who provide information for dealing with health issues in a simple and easy-to-understand manner