The Relationship of Diabetes and Skin Conditions
It is estimated that 30 million people in the United States are affected by diabetes, of which one-third are anticipated to develop a skin problem over the course of the disease. In fact, the American Diabetes Association states that some skin conditions are actually considered an indicator or warning sign of diabetes. There are a number of common skin problems that are aggravated by diabetes, particularly bacterial infections, and diabetes also increases the risk of specific conditions that may occur as a result of the disease. Dr. Timani would like to share that the majority of these medical dermatology conditions can be treated if intercepted in the early phases. Most importantly, attentive management of blood glucose levels is extremely influential in deterring development of diabetes related skin disorders.
WHAT CAUSES DIABETES INDUCED SKIN DISORDERS?
There are two prevalent causes of diabetic skin problems associated with high glucose levels: blood flow to the skin is reduced, which can also damage blood vessels and nerves; and weakened ability to fight infection. As well, certain kinds of medications which lower blood glucose levels may contribute to the potential for development of skin maladies.
Decreased Blood Circulation: Long term diabetes that is not well-controlled can lead to alterations in collagen’s texture, appearance and ability to heal. Damage to the skin’s vascular cells may increase sensitivity to temperature and pressure, or reduce one’s ability to sweat.
Reduced Ability to Fight Infection: Although a bacterial skin infection can affect anyone, the physiognomies of diabetes itself diminishes the body’s ability to produce the necessary defenses against bacteria. As such, when blood glucose levels are not controlled adequately, bacterial induced infections, particularly Staph and Strep, are prone to intensify in size, number and frequency.
OVERVIEW OF SKIN CONDITIONS COMMON TO DIABETICS
There are two general categories of diabetes, and certain skin conditions may be type specific. Type I insulin-dependent diabetes occurs when the body makes too little or no insulin. Type II non-insulin dependent diabetes develops when the body cannot use the insulin it makes. In general, Type II diabetics are more prone to bacterial infections and other skin problems than Type I. In either case, glucose is not metabolized to store and provide fuel for cells’ energy. It is important that persons with diabetes continually monitor themselves for injuries, insulin injection site irritation, cuts or wounds that do not heal normally, and other differences in their skin not previously present.
Bacterial Infections: Diabetics are more susceptible to Staph and Strep related sores and irritations. When serious, they can erupt as deep tissue infections termed carbuncles which require medical incision and drainage. Other common bacterial infections include boils, eyelid sties, hair follicles, and around the fingernails and toenails. Infected areas are hot, red, painful, and swollen, and may drain pus.
Fungal Infections: The most common fungus, Candida albicans, usually exhibits in warm, moist areas like armpits, under breasts, the groin, in the corners of the mouth, or between the toes, and is typified by a red, itchy rash which may be surrounded by small blisters and scales. Ringworm, vaginal yeast infections, jock itch, and athlete’s foot are examples. Without treatment they can spread and intensify in severity.
Neuropathy Related Disorders: One of the most common symptoms of diabetes, nerve damage causes a loss of sensation in the feet and as a result you can’t feel an injury, cut, blister, etc. If left untreated, an open sore which does not heal, known as a foot ulcer, may develop, and foot ulcers frequently becomes infected. Although fairly rare, blisters that resemble burns may arise on backs of fingers, hands, toes, feet, and sometimes on the legs or forearms when glucose levels are not managed well.
Atherosclerosis: Thickening of the arteries interferes with blood flow to the legs. Feet and toes become cold and hairless, with shiny skin, thickened toenails, and leg pain.
Digital Sclerosis: Common to approximately one-third of Type 1 diabetics, thick, tight, waxy skin develops on the backs of the hands, accompanied by stiffness in the finger joints. Skin on toes and forehead may also change, and sometimes stiffness may also be felt in knees, ankles, or elbows.
Other Diabetic Dermopathy and Skin Irritations: A number of other general dermatology skin irritations are common due to damage to the small blood vessels that supply tissues with nutrients and crucial oxygen. These may present in many different disorders, all of which itch:
• Itchy, dry skin, particularly on the lower extremities;
• Light brown, oval or circular scaly patches of skin, which in more severe cases turn shiny with red or violet borders and become painful;
• Flesh, red or red/brown colored raised, itchy bumps or rings on the hands, ears or feet that resemble a rash;
• Eruptive firm, yellow, pea-like itchy skin growths outlined by red halos, found on upper and lower extremities, and buttocks – typically associated with young Type I males with uncontrolled high cholesterol and very high triglycerides.
• A preliminary indicator of diabetes in overweight patients, skin in body folds and creases (underarms, groin, elbows neck, behind the knees) becomes dark, thick, and velvety looking.
WHAT ARE THE TREATMENT OPTIONS?
For patients with either form of diabetes, it is important to schedule an appointment with Dr. Timani at our conveniently located office in Johns Creek, serving the communities of Alpharetta, Milton, south Forsyth and north Fulton areas, to evaluate your symptoms. In most cases, if identified in early stages, treatment plans for diabetic skin disorders may include: an oral antibiotic or antibiotic cream; an oral or topical corticosteroid to reduce inflammation and itching; anti-fungal medications; moisturizers; and cholesterol medications. Dr. Zack in the Family Medicine component of our practice works with diabetic patients to establish a healthy diet, weight management program, and vigilant maintenance of blood glucose levels.