Skin Deep: Uncover the Truth About Diabetes and Your Skin

Introduction

Did you know that as many as 1 in 3 people with diabetes will develop a skin condition at some point?^[6] That’s right – while most people think of diabetes as a disease that affects blood sugar, it can also have a major impact on the body’s largest organ: the skin.

In this comprehensive guide, we’ll dive deep into the complex relationship between diabetes and skin health. From common skin conditions to prevention and treatment strategies, you’ll learn everything you need to know to keep your skin looking and feeling its best.

So let’s get started on this journey to uncover the truth about diabetes and your skin!

What is Diabetes?

Before we talk about how diabetes affects the skin, let’s take a step back and define what diabetes actually is.

Diabetes is a chronic condition that occurs when the body can’t properly use or produce insulin, a hormone that regulates blood sugar. There are two main types of diabetes:

• Type 1 diabetes: This type is an autoimmune disorder in which the body attacks and destroys the insulin-producing cells in the pancreas. People with type 1 diabetes need to take insulin injections to survive.
• Type 2 diabetes: This is the most common type of diabetes, accounting for 90-95% of cases. In type 2 diabetes, the body becomes resistant to insulin or doesn’t produce enough of it. Risk factors include being overweight, having a family history of diabetes, and being inactive.^[2]

Both types of diabetes can lead to high blood sugar levels over time, which can damage various organs and tissues in the body, including the skin.

The Link Between Diabetes and Skin Health

So how exactly does diabetes affect the skin? There are a few key mechanisms at play:

1. High blood sugar: Persistently elevated glucose levels can damage blood vessels and nerves, reducing circulation and sensation in the skin. This can lead to dryness, itching, and slow wound healing.^[6]
2. Impaired immune function: Diabetes can weaken the immune system, making the skin more susceptible to bacterial and fungal infections.
3. Insulin resistance: In type 2 diabetes, the body’s cells become resistant to insulin, which can cause a buildup of insulin in the bloodstream. High insulin levels can trigger skin changes like darkening and thickening.^[2]
4. Inflammation: Chronic inflammation is a hallmark of diabetes and can contribute to various skin issues.

These factors can set the stage for a wide range of skin conditions in people with diabetes. In fact, skin problems are often the first visible sign of diabetes, even before a formal diagnosis is made.^[1]

Common Skin Conditions Associated with Diabetes

Now that we understand the link between diabetes and skin health, let’s take a closer look at some of the most common skin conditions that can occur in people with diabetes.

Diabetic Dermopathy

Diabetic dermopathy is one of the most frequent skin manifestations of diabetes, affecting up to 50% of people with the condition.^[2] Also known as shin spots, this condition is characterized by:

• Light brown, scaly patches on the shins or other bony parts of the body
• Patches that are round or oval in shape
• Lesions that don’t cause any pain or itching
• Spots that are typically bilateral (occurring on both sides of the body)

While the exact cause of diabetic dermopathy is unknown, it’s thought to be related to diabetic nerve and blood vessel damage. The condition is more common in older adults and those who have had diabetes for a long time.^[2]

Fortunately, diabetic dermopathy is harmless and doesn’t require treatment. The spots usually go away on their own within 1-2 years, although new ones may appear. Keeping blood sugar levels in check can help prevent new lesions from forming.

Acanthosis Nigricans

Acanthosis nigricans is a skin condition that causes dark, thick, velvety patches in body folds and creases. Common sites include the neck, armpits, groin, and under the breasts.

While acanthosis nigricans can affect anyone, it’s particularly common in people with insulin resistance or type 2 diabetes. In fact, it’s often an early warning sign of diabetes or prediabetes.^[2]

Other risk factors for acanthosis nigricans include:

• Obesity
• Polycystic ovary syndrome (PCOS)
• Certain medications, such as corticosteroids or birth control pills
• Rarely, certain types of cancer

Treatment for acanthosis nigricans focuses on addressing the underlying cause, such as losing weight or managing diabetes. Topical medications like retinoids or alpha hydroxy acids may help improve the appearance of the skin.

Diabetic Foot Ulcers

Foot problems are a common complication of diabetes, and one of the most serious is diabetic foot ulcers. These are open sores or wounds that typically occur on the bottom of the foot.

Diabetic foot ulcers are caused by a combination of factors, including:

• Peripheral neuropathy (nerve damage) that reduces sensation in the feet
• Poor circulation that impairs wound healing
• High blood sugar that weakens the immune system and increases the risk of infection

Foot ulcers can be very painful and may take weeks or months to heal. If left untreated, they can become infected and lead to serious complications like gangrene or amputation.

Prevention is key when it comes to diabetic foot ulcers. Some strategies include:

• Checking your feet daily for cuts, blisters, redness, or swelling
• Wearing well-fitting shoes and socks
• Keeping your feet clean and dry
• Managing your blood sugar levels
• Not walking barefoot, even indoors

If you do develop a foot ulcer, it’s important to seek prompt medical attention. Treatment may involve cleaning and dressing the wound, taking antibiotics to clear any infection, and using special footwear or casts to reduce pressure on the area.

Necrobiosis Lipoidica

Necrobiosis lipoidica is a rare skin condition that affects about 0.3% of people with diabetes.^[2] It causes shiny, reddish-brown patches on the shins or other parts of the legs.

The patches may start out small but can gradually grow and merge to form larger areas. As the condition progresses, the center of the patch may become yellowish and develop a waxy texture. Ulceration (breakdown of the skin) can occur in severe cases.

The exact cause of necrobiosis lipoidica is unknown, but it’s thought to be related to diabetic blood vessel damage and inflammation. Other risk factors include:

• Being female
• Having type 1 diabetes
• Having had diabetes for a long time
• Poor blood sugar control

Treatment options for necrobiosis lipoidica include:

• Topical corticosteroids to reduce inflammation
• Oral medications like aspirin or pentoxifylline to improve blood flow
• Ultraviolet light therapy
• In severe cases, surgery to remove the affected skin

Keeping blood sugar levels well-controlled can help prevent necrobiosis lipoidica from developing or worsening.

Eruptive Xanthomas

Eruptive xanthomas are small, yellowish, pea-like bumps that suddenly appear on the skin. They’re often itchy and tender and can occur anywhere on the body, but are most common on the arms, legs, and buttocks.

Eruptive xanthomas are caused by high levels of blood fats (lipids) like cholesterol and triglycerides. In people with diabetes, they’re often a sign of uncontrolled blood sugar and insulin resistance.^[2]

Treatment involves managing the underlying cause, such as improving blood sugar control and taking lipid-lowering medications. The bumps usually go away on their own once lipid levels are back to normal.

Granuloma Annulare

Granuloma annulare is a skin condition that causes raised, reddish or skin-colored bumps that form ring patterns. The bumps are usually asymptomatic (not painful or itchy) and occur on the hands, feet, elbows, or knees.

While the exact cause of granuloma annulare is unknown, it’s more common in people with diabetes. In fact, a type called generalized granuloma annulare develops in up to 10% of people with diabetes.^[2]

Granuloma annulare usually goes away on its own within a few months to a few years. Treatment, if needed, may include:

• Topical corticosteroids
• Oral medications like niacinamide or isotretinoin
• Light therapy
• Cryotherapy (freezing) for individual bumps

Controlling blood sugar levels may help prevent or improve granuloma annulare in people with diabetes.

Understanding the Mechanisms

Now that we’ve covered some of the most common skin conditions associated with diabetes, let’s take a closer look at the underlying mechanisms that contribute to these issues.

Hyperglycemia and Skin Changes

Hyperglycemia, or high blood sugar, is the hallmark of diabetes and can have far-reaching effects on the skin. When glucose levels are consistently elevated, it can lead to a process called glycation.

Glycation occurs when excess sugar molecules attach to proteins and lipids in the body, forming advanced glycation end products (AGEs). AGEs can accumulate in various tissues, including the skin, and cause inflammation and oxidative stress.^[2]

In the skin, glycation can damage collagen and elastin fibers, the proteins that give skin its strength and elasticity. This can lead to premature aging, wrinkles, and sagging.

Hyperglycemia can also impair the function of keratinocytes, the main cell type in the epidermis (outer layer of skin). Keratinocytes play a key role in maintaining the skin barrier and producing lipids that keep the skin hydrated. When their function is disrupted, it can lead to dryness, itching, and increased susceptibility to infections.^[2]

Impaired Circulation and Nerve Damage

In addition to its direct effects on the skin, hyperglycemia can also damage blood vessels and nerves, leading to impaired circulation and sensation.

Diabetic neuropathy, or nerve damage, is a common complication of diabetes that can affect up to 50% of people with the condition. It occurs when high blood sugar levels damage the small blood vessels that supply the nerves, leading to reduced blood flow and oxygen delivery.^[6]

In the skin, neuropathy can cause a loss of sensation, particularly in the feet and legs. This can make it difficult to feel pain, pressure, or temperature changes, increasing the risk of injuries and infections.

Poor circulation can also contribute to skin problems in people with diabetes. When blood flow is reduced, it can impair wound healing, leading to slow-healing sores or ulcers. It can also cause skin changes like thinning, dryness, and loss of hair.^[6]

Increased Susceptibility to Infections

Diabetes can weaken the immune system, making the skin more vulnerable to bacterial and fungal infections. In fact, people with diabetes are more likely to develop skin infections than those without the condition.^[2]

There are a few reasons for this increased susceptibility:

1. High blood sugar levels can impair the function of white blood cells, the immune cells that fight off infections.
2. Nerve damage and poor circulation can reduce blood flow to the skin, making it harder for the body to deliver immune cells and nutrients to the site of an infection.
3. Excess glucose in the skin can serve as a food source for bacteria and fungi, allowing them to grow and multiply more easily.

Some common skin infections in people with diabetes include:

• Staphylococcus (staph) infections, which can cause boils, folliculitis, and cellulitis
• Candida (yeast) infections, which often occur in warm, moist areas like the armpits, groin, and under the breasts
• Dermatophyte (fungal) infections, such as athlete’s foot and ringworm

Preventing and promptly treating skin infections is important to avoid serious complications like sepsis (blood infection) or necrotizing fasciitis (flesh-eating disease).

Managing Skin Issues Related to Diabetes

If you have diabetes, taking care of your skin is an essential part of your overall health management plan. Here are some strategies for preventing and treating common skin issues.

Blood Sugar Control

The most important thing you can do for your skin (and your overall health) is to keep your blood sugar levels within a healthy range. This means:

• Following a balanced, diabetes-friendly diet that’s low in added sugars and refined carbs
• Getting regular physical activity
• Taking diabetes medications as prescribed
• Monitoring your blood sugar levels regularly

Good blood sugar control can help prevent skin complications from developing in the first place and may also improve existing skin issues.^[6]

Skin Care Practices

In addition to managing your diabetes, adopting a good skin care routine can go a long way in keeping your skin healthy. Some tips include:

• Keeping your skin clean and dry, especially in areas prone to infection like the feet and skin folds
• Using mild, fragrance-free cleansers and moisturizers to avoid irritation
• Applying moisturizer after bathing to lock in hydration
• Protecting your skin from the sun with broad-spectrum sunscreen and protective clothing
• Not sharing personal care items like razors or towels to avoid spreading infections

If you have specific skin concerns, don’t hesitate to consult with a dermatologist who has experience treating people with diabetes. They can recommend products and practices tailored to your individual needs.

Early Detection and Treatment

Catching and treating skin problems early can help prevent them from becoming more serious. That’s why it’s important to perform regular self-exams and see your healthcare provider for any concerning changes.

When examining your skin, look out for:

• New or changing moles, spots, or patches
• Sores or wounds that are slow to heal
• Redness, swelling, or warmth, which could indicate an infection
• Cracks, blisters, or calluses, especially on the feet

If you notice any of these issues, don’t try to treat them yourself with over-the-counter products. See your healthcare provider or dermatologist for an accurate diagnosis and appropriate treatment plan.

Prevention and Lifestyle Modifications

In addition to medical management, making healthy lifestyle choices can help prevent and control diabetes-related skin problems. Here are some key areas to focus on.

Healthy Diet and Exercise

Eating a balanced, nutrient-rich diet and getting regular physical activity are important for both blood sugar control and skin health.

Some dietary tips for healthy skin include:

• Focusing on whole, minimally processed foods like fruits, vegetables, whole grains, and lean proteins
• Limiting added sugars, refined carbs, and unhealthy fats
• Staying hydrated by drinking plenty of water throughout the day
• Considering supplements like omega-3 fatty acids and vitamins C and E, which may help support skin health (talk to your doctor first)

Exercise is also crucial for managing diabetes and promoting healthy skin. Aim for at least 150 minutes of moderate-intensity aerobic activity (like brisk walking) per week, plus two sessions of strength training.^[6]

Physical activity helps improve insulin sensitivity, lower blood sugar levels, and reduce inflammation throughout the body. It also increases blood flow to the skin, delivering oxygen and nutrients that promote wound healing and overall skin health.

Regular Skin Exams

Performing regular self-exams and seeing a dermatologist for annual skin checks can help catch potential problems early, when they’re easier to treat.

When examining your skin at home, follow the ABCDE rule for spotting suspicious moles or spots:

• Asymmetry: One half of the spot doesn’t match the other half.
• Border: The edges are irregular, ragged, or blurred.
• Color: The color is not uniform and may include shades of brown, black, red, white, or blue.
• Diameter: The spot is larger than 6 millimeters (about the size of a pencil eraser).
• Evolving: The spot is changing in size, shape, or color over time.

If you notice any spots that fit these criteria, make an appointment with a dermatologist for a professional evaluation. They may perform a skin biopsy to check for skin cancer or other conditions.

Foot Care

Foot problems are some of the most common and serious complications of diabetes, so it’s important to take extra care of your feet. Some tips include:

• Inspecting your feet daily for cuts, blisters, redness, or swelling
• Washing your feet daily with warm water and mild soap, and drying them thoroughly
• Applying moisturizer to your feet (but not between the toes) to prevent dryness and cracking
• Trimming your toenails straight across and filing any sharp edges
• Always wearing clean, dry socks and well-fitting shoes
• Not going barefoot, even indoors
• Seeing a podiatrist regularly for professional foot exams and nail care

If you have nerve damage or poor circulation in your feet, you may need to take extra precautions to prevent injuries and infections. Your healthcare provider can recommend specific foot care practices based on your individual needs.

Conclusion

As we’ve seen, diabetes can have a significant impact on skin health, leading to a variety of conditions and complications. However, by understanding the link between diabetes and skin problems, and taking proactive steps to manage your health, you can keep your skin looking and feeling its best.

The key takeaways from this guide are:

• High blood sugar levels can damage the skin and increase the risk of infections and other problems.
• Common skin conditions in people with diabetes include diabetic dermopathy, acanthosis nigricans, diabetic foot ulcers, necrobiosis lipoidica, eruptive xanthomas, and granuloma annulare.
• Keeping blood sugar levels in a healthy range through diet, exercise, and medication is crucial for preventing and managing skin issues.
• Good skin care practices, such as keeping skin clean and moisturized, can help maintain skin health.
• Early detection and treatment of skin problems can prevent them from becoming more serious.
• Making healthy lifestyle choices, like eating a balanced diet and getting regular exercise, can support both diabetes management and skin health.

Remember, if you have diabetes, you don’t have to face skin problems alone. Work with your healthcare team, including your primary care provider, endocrinologist, and dermatologist, to develop a personalized plan for preventing and managing skin issues.

By taking charge of your health and making skin care a priority, you can enjoy healthy, radiant skin for years to come.

Takeaways

• Diabetes can affect the skin in many ways, leading to conditions like diabetic dermopathy, acanthosis nigricans, and diabetic foot ulcers.
• High blood sugar levels can damage skin cells and blood vessels, increasing the risk of infections and other problems.
• Keeping blood sugar levels in a healthy range through diet, exercise, and medication is key for preventing and managing diabetes-related skin issues.
• Good skin care practices, like keeping skin clean and moisturized, can help maintain skin health in people with diabetes.
• Early detection and treatment of skin problems is important to prevent complications.
• Making healthy lifestyle choices, such as eating a balanced diet and getting regular exercise, can support both diabetes management and skin health.

FAQs

Can diabetes cause itching?

Yes, diabetes can cause itching, also known as pruritus. This can be due to dry skin, yeast infections, or poor circulation. Keeping your skin moisturized, managing your blood sugar levels, and avoiding hot showers or baths can help alleviate itching. If the itching is severe or persists despite self-care measures, see your healthcare provider.

How can I tell if a cut or sore is infected?

Signs of an infected cut or sore include:

• • Redness, swelling, or warmth around the area
  • Pus or drainage from the wound
  • Pain or tenderness
  • Fever or chills
  • Red streaks extending from the wound

If you notice any of these signs, see your healthcare provider right away. Prompt treatment with antibiotics can help clear the infection and prevent it from spreading.

Can I use over-the-counter treatments for skin problems?

It’s best to check with your healthcare provider or dermatologist before using any over-the-counter treatments for diabetes-related skin problems. Some products, like those containing harsh chemicals or fragrances, may actually worsen skin irritation or dryness. Your healthcare team can recommend gentle, effective treatments that are safe for your skin.

How often should I see a dermatologist if I have diabetes?

It’s a good idea to see a dermatologist at least once a year for a full-body skin exam, even if you don’t have any specific skin concerns. This can help catch potential problems early, when they’re easier to treat. If you have a history of skin cancer or other skin conditions, you may need to see a dermatologist more frequently. Ask your primary care provider or endocrinologist for a referral.

Can diabetes cause hair loss?

Yes, diabetes can contribute to hair loss or thinning in some people. This may be due to hormonal changes, poor circulation, or nutrient deficiencies. Keeping your blood sugar levels in a healthy range, eating a balanced diet, and managing stress can help support healthy hair growth. If you’re experiencing significant hair loss, talk to your healthcare provider to rule out other underlying causes.

References

1. American Diabetes Association. (2021). 11. Microvascular complications and foot care: Standards of medical care in diabetes—2021. Diabetes Care, 44(Supplement 1), S151-S167.
2. Bustan, R. S., Wasim, D., Yderstræde, K. B., & Bygum, A. (2017). Specific skin signs as a cutaneous marker of diabetes mellitus and the prediabetic state–a systematic review. Danish medical journal, 64(1), A5316.
3. Duff, M., Demidova, O., Blackburn, S., & Shubrook, J. (2015). Cutaneous manifestations of diabetes mellitus. Clinical diabetes, 33(1), 40-48.
4. Gönül, M., Cemil, B. Ç., Keseroglu, H. Ö., & Akis, H. K. (2014). Acanthosis nigricans in obese adolescents and its relationship to metabolic syndrome. Journal of clinical research in pediatric endocrinology, 6(2), 98.
5. Lima, A. L., Illing, T., Schliemann, S., & Elsner, P. (2017). Cutaneous manifestations of diabetes mellitus: a review. American journal of clinical dermatology, 18(4), 541-553.
6. Mendes, A. L., & Miot, H. A. (2017). Diabetes mellitus and the skin. Anais brasileiros de dermatologia, 92, 8-20.
7. Parada, H., Veríssimo, C., Brandão, I., & Nunes, J. P. (2013). Skin infections in diabetics. Acta medica portuguesa, 26(1), 27-36.
8. Rosen, J., & Yosipovitch, G. (2018). Skin manifestations of diabetes mellitus. In Endotext [Internet]. MDText. com, Inc..
9. Santoro, F., & Guida, A. (2019). Skin complications in diabetes mellitus: an update on pathogenesis and management. Italian Journal of Dermatology and Venereology, 154(6).
10. Van Hattem, S., Bootsma, A. H., & Thio, H. B. (2008). Skin manifestations of diabetes. Cleveland Clinic journal of medicine, 75(11), 772.