Skin Care & Diabetes Reviewed By: Nikheel Kolatkar, M.D. Summary Diabetes can affect almost every part of the body. It frequently causes skin problems. In some cases, these conditions are specific to people with diabetes. For example, the skin of diabetic individuals tends to be thicker than that of nondiabetics. Other conditions, such as dry skin, are common in the general population but may be more severe for people with diabetes. Many diabetic skin problems occur when glucose (blood sugar) levels are too high. High glucose (hyperglycemia) causes fluid loss because the body turns water into urine in an attempt to rid the body of the excess glucose. People with diabetes who develop skin conditions are advised to seek medical treatment. This is particularly true if the condition causes itchiness and chronic scratching, which can lead to infection and cause complications. People with diabetes can take precautions to ward off skin problems. Controlling glucose levels is the primary means of preventing skin from drying or becoming infected with bacteria. Patients can also take other steps, such as using a humidifier to keep air moist in the winter or keeping skin clean and moisturized. In addition, skin ointments can help people with diabetes treat some skin conditions. These ointments include emollients, urea-based products, and corticosteroid and antimicrobial creams. Different ointments are appropriate for different conditions. For example, moisturizers can prevent dry skin, which occurs when high glucose levels or the nerve disease diabetic neuropathy cause the body to lose fluids. Antibiotic creams may treat bacterial infections, and antifungals help fight nail fungus and yeast infections. About skin care and diabetes Skin problems are a common complication of diabetes. As many as one-third of people with diabetes experience a skin disorder at some point in their lives, according to the American Diabetes Association (ADA). In some cases, skin disorders are the first symptom of diabetes that a patient experiences. Skin conditions are often more dangerous to people with diabetes than they are to the general population. The high levels of glucose (blood sugar) associated with diabetes prevent rapid healing, allowing even minor cuts to progress to serious infections. Diabetic skin conditions include: Dry skin. This is the source of many common skin disorders suffered by people with diabetes. It frequently causes itchiness (pruritus) that is aggravated further when patients rub or scratch. Diabetes can cause or promote dry skin in two ways: High glucose (hyperglycemia). As blood glucose levels increase, the body loses fluids. This dehydration causes the skin to dry, leading to itchiness and cracking. Skin opened from cracking or intensive scratching is more vulnerable to infection. Areas that commonly dry out and become itchy or cracked include legs, feet and elbows. Nerve damage (neuropathy). People with diabetes often suffer nerve damage, which prevents body parts from receiving the signal to perspire. As a person stops sweating, the skin dries out.  In people with diabetes, the feet and legs are most vulnerable to this disorder. Dry skin (also called xerosis or asteatosis) is particularly common in elderly people with diabetes. Sometimes, dry skin caused by diabetes appears in localized regions on the body. In other cases, it may be more widespread. As the skin becomes rough and scaly, it becomes itchy and the appearance degrades. Dry skin may also make a person with diabetes more vulnerable to eczema (acute or chronic skin inflammation) or other skin conditions. In the most severe cases, skin suppleness decreases and the skin cracks, leaving visible patches of erythema (redness or inflammation caused by dilation and congestion of the capillaries). Patients who scratch or rub the skin may cause these symptoms to become worse, or may trigger an infection of the skin. Dry skin can be present year-round but is most likely in the winter. Colder, drier air outdoors and drier air indoors (cause by indoor heating) can exacerbate symptoms. In addition, various soaps and detergents and excessive exposure to hot water can leech the natural oils from the skin, causing it to dehydrate. Skin infections. Elevated blood glucose levels prevent cells from adequately fighting bacteria. As a result, people with diabetes are prone to skin infections, including carbuncles and boils. Untreated cuts – even minor nicks – can deteriorate into deep, open sores known as ulcers. People with diabetes can take several preventive measures to ensure that their skin stays healthy. This includes keeping skin moisturized and clean. People with diabetes have to pay close attention to the skin on their feet, as this is a frequent site of skin injuries and often leads to complications. In some cases, medications may be necessary to treat a skin condition and to keep it from progressing. Skin ointments used to treat dry skin come in different forms and include: Emollients Urea-based products Corticosteroids Antibiotic creams The National Skin Care Institute advises people with diabetes that regular use of oil-based products can reduce the skin’s creation of natural oils. It recommends shielding lotions, which protect the skin from loss of moisture, draw additional moisture from the air, protect against irritants and are not lost during bathing. Types of skin conditions People with diabetes are prone to several kinds of skin conditions resulting from high glucose (blood sugar) levels. Some skin conditions occur only or mainly in people with diabetes. They include: Stiff-hand syndrome (digital sclerosis). Tight, thick, waxy skin that develops on the back of the hands and on the toes or forehead. Finger joints become stiff and can no longer move the way they should. Rarely, knees, ankles or elbows also stiffen. This condition occurs in about one-third of people with type 1 diabetes. It usually disappears when glucose levels are brought under control. Disseminated granuloma annulare. Appears as sharply defined ring-shaped or arc-shaped raised areas on skin on parts of the body far from the trunk. They can be red, red-brown or skin-colored. A physician may prescribe medication to clear up this condition. Acanthosis nigricans. Tan or brown raised areas that appear on the sides of the neck, armpits, groin, hands, elbows and knees. This condition most often occurs in those who are obese. Weight loss is the best treatment, but some creams can improve the skin's appearance. Conditions that are associated with diabetes, but which are also common in the general population, include: Allergic reactions. Can occur in response to medicines such as insulin or antidiabetic agents and appear as rashes, depressions or bumps at injection sites. Bacterial infections. Some common bacterial infections in people with diabetes include: Styes. Infections of the eyelid glands. Boils. Infections of the hair follicles. Carbuncles. Deep infections of the skin and the tissue underneath. Cellulitis. Bacterial infection of the skin and underlying tissues. Infections can also occur in other areas, such as surrounding the fingernails or toenails. Infections can cause tissues to become inflamed, leaving the area hot, swollen, red and painful. Staphylococcus bacteria, also called staph, are among the organisms that most often cause infections. Fungal infections. Often caused by Candida albicans, a yeast-like fungus that causes itchy rashes of moist, red areas surrounded by tiny blisters and scales. These infections often occur in warm, moist folds of the skin such as under the breasts, around the nails, between fingers and toes, in the corners of the mouth, in the armpits and groin, and under the foreskin of uncircumcised men. Itching (pruritus). Frequently caused by a yeast infection, dry skin or impaired circulation. Problems with circulation may cause itching in the lower leg.         Treatment and prevention of skin conditions Because skin conditions have such major consequences for people with diabetes, it is important to take preventative measures that will reduce the likelihood of suffering from dry skin or infections. To help keep skin healthy, people with diabetes are advised t Keep diabetes well-managed. High levels of glucose (blood sugar) tend to cause dry skin and prevent the body from keeping bacteria at bay. This hyperglycemia leaves the people with diabetes at greater risk of infection. High glucose reduces the body’s ability to fight bacteria. Keep skin clean and moisturized. Patients can use talcum powder where skin touches skin, such as in the armpits and groin. Bathe daily (except during cold, dry months). Keeping skin clean will reduce the likelihood of skin infections. Take measures to protect skin during cold, dry months. In winter, indoor air is heated, which decreases humidity. Outdoor air that is cold and dry can also dehydrate a person’s skin. Running a humidifier indoors can help keep the skin from drying out. Patients may be advised to bathe less frequently during these months, when practical. Keep baths and showers warm or lukewarm. This will help prevent skin from drying out. Bubble baths are not recommended. To keep skin from drying out, patients can use moisturizing soaps and oil-in-water skin creams. Moisturize skin. Dry or itchy skin can cause the patient to scratch excessively, which can open the skin and allow infection to set in. Moisturizing the skin can prevent chapping, especially in cold or windy weather. However, patients should not use lotion between the toes, as this can encourage fungus to grow. Treat minor cuts immediately with soap and water. Cover minor cuts with sterile gauze. Patients should see their physician promptly if they suffer a major cut, burn or infection. Use mild shampoos and soaps that will not dry out the skin by removing the skin’s natural oils (sebum). Avoid feminine hygiene sprays. Examine the body closely after bathing. Check for dry, red or sore spots that can lead to infection. Wear gloves when using cleaning agents, solvents or household detergents. Consider wearing natural fibers. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) recommends all-cotton underwear to let air circulate better around the skin. Take good care of the feet. Patients should check their feet every day for dry and cracked areas, sores and cuts. They should wear broad, flat shoes that fit well and check their shoes for foreign objects before wearing them. In some cases, medications may be necessary to treat skin conditions related to diabetes. Such ointments include: Emollients. Patients can apply products such as petrolatum or lanolin to their skin after bathing. This can help trap moisture in the skin. Emollients are especially effective when patients blot themselves dry after bathing and then apply a lotion, leaving a small amount of water on the skin that will be trapped by the lotion. Urea-based products.  Products containing 10 to 20 percent urea also hold moisture in the skin. Alphahydroxy acid (AHA) lotions restore the structure of dry skin. Urea and lactic acid mixtures are often not well-tolerated for dry skin on sensitive areas such as the face, and may sting if applied to unhealed cuts or rashes. In such locations, products with emollient bases may be better alternatives. Corticosteroids, antimicrobials or other medications. These treatments may be necessary in certain cases, such as when dry skin causes eczema-related changes or infections. A physician or dermatologist can perform a physical examination to determine whether such medications are necessary. Corticosteroids can raise glucose levels, and patients taking these medications should maintain regular contact with the healthcare team. Antibiotics can fight bacterial infections but not those caused by fungi, viruses or parasites. Antifungals can treat nail fungus, yeast infections or thrush. People with diabetes should also keep their own first-aid kit to immediately treat minor injuries and to prevent them from progressing. A kit should include: Antibacterial ointment and antifungal ointment Gauze pads Hypoallergenic tape or paper tape Prepackaged cleansing towelettes Patients are advised to consult their physician about which skin conditions can be treated at home and which need the attention of a dermatologist or other physician. Questions for your doctor regarding skin care  Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about skin care and diabetes: What kind of skin care should I do myself? How often should I perform skin care? Do you recommend certain skin care products for me? Are there any skin care products I should avoid? Can I occasionally use oil-based products, or should I use shielding lotions instead? Should I apply skin care products everywhere, or avoid them in places that may harbor moisture, such as between my toes? Should I bathe daily, or less often in cold and dry weather? Can the seasons affect my skin care routine in other ways? Are there certain things I should do only in summer or only in winter? How often should I have a doctor inspect my skin? Should I see a dermatologist regularly or only if I have certain conditions? What skin conditions require prompt medical attention? How can I prevent diabetic skin disorders?