Diabetes and Your Skin

From the WebMD Archives

Diabetes gives you a good reason to pamper your skin. You are more prone to skin problems like dryness. Scarring from insulin shots can affect how your body absorbs insulin. And because diabetes raises your chances of infection, even a minor skin condition can become a more serious problem.

People with diabetes "get everything!" says Kathy Kindelan, RN, a retired nurse who's had diabetes since her 20s. If you develop even a small skin problem, she says, "you have to treat it aggressively."

There are three main types of diabetes skin conditions, says Margo S. Hudson, MD, an instructor at Harvard Medical School:

  • Skin conditions that happen mostly to people with diabetes
  • Common skin infections made worse by having high blood sugar
  • Skin problems that occur from insulin shots

This guide will fill you in on common skin conditions linked to diabetes and how to prevent or care for them.

Common Skin Conditions With Diabetes

Many diabetes-related skin conditions harmless, but it's helpful to know what they look like and when to see your doctor for treatment.

Diabetic dermopathy. This appears as light brown, scaly, round spots on the shins. They look a lot like age spots but are caused by changes in your small blood vessels. "It's more of a cosmetic issue and doesn’t really require treatment," Hudson says.

Disseminated granuloma annulare. This causes red, red-brown, or skin-colored raised rings or arcs on the skin. They are likely to show up on your fingers, ears, or lower legs, but can also appear on the trunk of your body. Your doctor can prescribe a cortisone skin cream or another treatment.

Digital sclerosis. About one-third of people with type 1 diabetes have this condition. It can make the skin on the back of your hands thick, waxy, and tight. Your finger joints may become stiff and hard to move. You can also get it on your forehead and toes and, rarely, your elbows, knees, or ankles. Get your blood sugar under control to treat it.

Acanthosis nigricans . With this condition, the skin on your neck, armpits, or groin thickens and becomes brown or tan. "People think it's dirt and wonder why they can't clean it off," Hudson says. Insulin resistance causes it, most likely if you are overweight. Treatment includes losing weight and taking diabetes drugs, which help the body use insulin better.

Eruptive xanthomatosis. Young men with type 1 diabetes who also have high levels of cholesterol and fat in their blood often get this condition. It causes raised, yellow, pea-sized bumps that have a red halo and may itch. They appear on the hands, arms, feet, legs, and buttocks. Getting your blood sugar levels under control clears them up.

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Diabetes and Skin Infections

Bacterial skin infections are pretty common with diabetes, says Betul Hatipoglu, MD, of the Endocrinology and Metabolic Institute at Cleveland Clinic in Ohio. "It can be as simple as a boil in the armpit or on the face, infection of the hair follicles, or infection of the nail bed," she says. Almost a third of people with diabetes will get a skin infection at some time in their life, Hatipoglu says.

Fungal infections are pretty common too, she says. You are most likely to have them in areas that get hot and sweaty, including:

  • Under the breasts
  • Between fingers and toes
  • In the armpits
  • In the groin area
  • Around the tip of the penis, if you are an uncircumcised man

Athlete's foot, jock itch, and vaginal infections are very common in people without diabetes as well as people with it. But they can be harder to treat if you have diabetes.

So what's the best way to fight infection? "You have to make sure your blood sugars are within a normal range as much as possible," Hatipoglu says. "Bacteria and fungi like sugar, and they will multiply like crazy if you don't."

She suggests these tips to prevent and calm skin infections:

  • Check your feet and any areas of your body that get damp and sweaty every day.
  • Use moisturizer on dry skin daily to keep it from cracking and itching. Don't apply moisturizer between your toes, though.
  • If you think you have an infection anywhere on your body, call your doctor.
  • Don't try to treat skin infections at home with over-the-counter products, because they may not be strong enough.

Diabetes and Shot-Related Skin Problems

If you use insulin, you can have problems on your skin where you give yourself shots. Hudson says that two of the problems, hypertrophy and atrophy, were more common in the past, but they still happen.

  • Hypertrophy. If you keep doing your insulin shots in the same exact spot, a little mound of fat tissue can build up. It can be unsightly and keep your body from absorbing insulin as well.
  • Atrophy. With this less-common condition, Hudson says, "you actually lose the fatty tissue underneath an area of injection. So it's like a dimple." The way your body absorbs insulin may become erratic, making it hard to control your blood sugar levels.

Some people who use insulin pumps have an allergic reaction to the adhesive used to secure it to the skin. Others are allergic to some types of insulin. Reactions can range from swelling and itching to life-threatening symptoms. Your doctor can advise you on other options for either of these issues.

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Prevent Skin Problems From Insulin Shots

The key to keep insulin shots from causing skin problems is to rotate the place where you give them, Hudson and Hatipoglu say. If you use a syringe or pen, pick a new spot an inch or so away from the last one each time. If you use an insulin pump, rotate spots every 2 to 3 days. To prevent infection, wash your hands and the skin area first.

Kindelan, the retired nurse who's been injecting insulin for most of her adult life, says it has helped her avoid skin problems. "I've never had them," she says. Though she has a bit of scarring, Kindelan says, "you just don't use those sites if that happens. I take four injections a day, so I rotate sites."

Hatipoglu and Hudson also advise injecting insulin in different parts of the body. How fast your body will absorb it depends on the area you use -- such as the stomach, hips, thighs, arms, or buttocks.

"In the summer, I tend not to use my legs," Kindelan says. "I think everybody feels kind of weird about using their stomach, and I avoided it for a while. Then it just seemed like too much prime territory, and it wasn't going to show. It's decidedly the most painless of all areas."

WebMD Feature Reviewed by Brunilda Nazario, MD on February 14, 2014

Sources

SOURCES:

Richardson, T. American Journal of Clinical Dermatology, 2003.

Radermecher, R. American Journal of Clinical Dermatology, 2007.

Margo S. Hudson, MD, instructor, Harvard Medical School; endocrinologist, Brigham and Women's Hospital; Boston.

Kathy Kindelan, RN, retired nurse.

Betul Hatipoglu, MD, endocrinologist, Endocrinology and Metabolic Institute, Cleveland Clinic, Ohio.

American Diabetes Association: "Skin Complications."

Joslin Diabetes Center: "How to Improve the Insulin Injection Experience," "Good Skin Care and Diabetes."

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