Part of diabetes management involves managing the common skin conditions associated with the disease. Find out what they are here.
What is Diabetes Mellitus?
Diabetes mellitus is a common disease affecting about eight percent of the adult population in Singapore. Diabetics have high blood sugar levels which, if not controlled well, may lead to long-term complications affecting various organs, such as the eyes, kidneys, nervous system and blood vessels.
Skin problems are common in diabetics. Some skin diseases are characteristically associated with diabetes.
Management of diabetes mellitus involves daily monitoring of blood sugar levels with a diabetes glucose monitor. It is also important to know about potential complications, like skin diseases, that may result from the condition.
What are Some Common Skin Diseases Associated with Diabetes?
Diabetic Dermopathy
This is the most common skin disease seen in diabetics. Skin signs are commonly found over the shins and appear as brown scars. The brown spots may be preceded by red or blistering spots. This condition is caused by abnormal changes of small blood vessels in the skin. There is no specific treatment for this skin disorder. The condition tends to heal by itself into depressed scars.
Gangrene
Occlusion (closing) of large vessels in the feet due to diabetes can cause pain during prolonged walking as a result of poor blood circulation. Severe occlusion can lead to gangrenous changes of the toes as a result of tissue death. Surgery may be needed to remove the dead tissues and in severe cases, amputation of the foot or leg.
Diabetic Neuropathy
Diabetes may damage nerves as a result of poor blood circulation. This can cause a burning and tingling sensation and numbness of the feet. Patients may also have reduced or no pain sensation and may develop skin sores and ulcers on the feet due to trauma, if good foot care is not included in everyday diabetes maintenance.
Skin Infections
Diabetics are more prone to skin infections such as styes, boils and fungal infection. Some infections can be serious and require immediate medical attention eg. carbuncles, which are deep bacterial infections of the hair follicle (abscess), and cellulitis, which is a deep skin infection. Cellulitis often presents as a red, hot and tender swelling of the leg.
Necrotising fasciitis is a serious and life-threatening skin infection which may extend deep down to the muscles and requires immediate treatment and surgery. It presents as painful, inflammed haemorrhagic swelling or blistering of the skin.
Necrobiosis Lipoidica
This is a rare complication of diabetes, again due to small blood vessel disease of the skin. Skin lesions usually appear on the shin. The affected skin has a reddish-brown border with a yellowish centre. Sometimes, the onset of this skin disease may precede the diagnosis of diabetes and so patients with this skin disorder need to be screened for diabetes.
Acanthosis Nigricans
This is a skin manifestation of diabetes. It is also a sign of other internal diseases including hereditary diseases and internal cancer. It is commonly seen in those who are obese. Skin changes are characterised by dark, brownish-black velvety thickening of the skin folds such as the armpits, upper back, neck and groins.
Xanthomas and Xanthelasma
Diabetics often suffer from high lipid (cholesterol and triglycerides) levels in the blood. This causes fats to be deposited in the skin and presents as xanthomas or xanthelasma.
Xanthomas are symptomless yellow firm nodules usually found over bony elbows, knees and heels. Sometimes, they appear as pinhead-sized yellow lumps or in crops over the buttocks (eruptive xanthomas).
Xanthelasma is a sign of high cholesterol levels in the blood and presents as yellow patches on the eyelids. Treatment is aimed at normalising the lipid levels by dietary restriction of saturated fats and if necessary, medical treatment with lipid-lowering drugs.
Granuloma Annulare
This is a skin disease seen usually in children and young adults. It is occasionally associated with diabetes. Skin signs include red spots in the initial stages which expand outwards in a ring-like fashion. Hands, especially the fingers, and elbows are commonly affected.
When granuloma annulare is widespread, it may be associated with underlying diabetes mellitus. The skin lesions may precede the symptoms and signs of diabetes mellitus. Patients with widespread granuloma annulare need to be screened for diabetes mellitus.
How to Manage Diabetes-associated Skin Conditions?
When there are serious complications, such as bacterial skin infections or gangrene, seek immediate medical attention. Consult your doctor early. You may need to be hospitalised. With poor management of diabetes mellitus skin conditions, complications may be life-threatening. Infected ulcers need to be treated with antibiotics.
Control of Diabetes-related Skin Conditions
With proper management of diabetes mellitus, many of these skin problems can be averted. This requires compliance with a diabetic diet, medication and regular check-ups with your doctor. Proper skin and foot care is important:
• Do not walk barefoot to avoid skin injuries.
• Check your feet every day for cuts and sores. Pay special attention to the spaces in between the toes to look for inflammation and infection.
• Wear proper-fitting shoes that are not too tight or loose to prevent skin trauma.
• Cut toenails carefully.
• If skin sores or ulcers develop, see a doctor immediately. Some skin signs are also an indication that there may be possible complications affecting other organs in the body, such as the eyes and kidney. Your doctor will check for these complications.
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