Diabetes and the skin

Diabetes mellitus best known as Diabetes or “Bolwetse jwa sukiri” is a chronic disease of metabolism, which causes the body to have raised blood glucose “sugar”. Diabetes results from impairment of body mechanisms that are necessary to produce or utilise the hormone insulin. While its commonly seen in adults, it can affect children, adolescents and women during pregnancy. The skin is the biggest organ in the human body and it tells a lot of stories about what is going on in the internal organs. By no means is the skin spared from the complications that arise from uncontrolled diabetes. There are certain skin signs and symptoms that may be regarded as warning signs of glucose impairment or diabetes. Though some signs and symptoms are of cosmetic concern, it is important to see a dermatologist to carefully evaluate your skin if you are a patient diagnosed with Diabetes or impaired glucose tolerance. When diabetes affects the skin, this may be an indication that treatment needs to be adjusted.

Dr Neo Sekgoma discuses selected

skin problems linked to diabetes:

Skin infections

“The skin of Diabetic patients is easily colonised by fungal and bacterial infections”, says Dr Sekgoma. Fungal infections such as candida tend to occur in the warm moist areas of the skin, such as under the breasts, armpits, groin, and between the fingers and toes. This results in skin rashes that tend to be very itchy, red and uncomfortable. Common fungal infections include vaginal yeast “thrush” infection, athletes foot and ring worms.

Bacterial infections most commonly caused by staphylococcus or streptococcus bacteria, present as pustules and abscesses of the skin, hair, and nails. These include folliculitis which is an infection of the hair follicles, “paronychia”-nail fold infections, styes and infections of the eye, “carbuncles”- deep abscess of the skin and formation of boils. Bacterial skin lesions tend to be painful, red and hot to touch.

Sekgoma explains that in as much as some infections are localised, some can become very deep and serious leading to hospital admissions.

Antifungal and antibacterial medications are imperative for skin infections and should be administered under the care and instruction of a health care worker.

Open wounds

Dr Sekgoma highlights that the skin barrier in individuals with poorly controlled diabetes tends to be compromised due to poor circulation and nerve damage. Impaired circulation and nerve damage leads to poor wound healing resulting in Diabetic Foot ulcers. Diabetic Foot ulcers develop at sites of pressure particularly on the feet. These can become a nightmare for diabetic patients and can eventually lead to gangrene. Gangrene of toes or limbs lead to surgical interventions such as amputations which impair the quality of life of the patient.

Blisters

Bullosis diabeticorum a condition characterised by large painless blisters may form on the arms, hands, legs and feet of patients with high glucose “sugar” levels.

Hard thickened skin

Diabetic cheiroathropathy leads to thickened and hardened skin of the hands and fingers. This leads to joint stiffness and disability of the hands. Physiotherapy, rehabilitation and occupational therapy interventions can help ameliorate the degree of disability.

Skin tags

Acrochordons commonly known as skin tags are flesh coloured or darkly pigmented small skin lesions that hang on a stalk. They occur mainly on the armpits, groin, and neck. Dr Sekgoma highlights that when skin tags are numerous this may be a sign of glucose impairment or diabetes. Dermatologist can remove the skin tags for cosmetic purposes.

Acanthosis Nigricans

Acanthosis nigricans a skin condition which presents as velvety black or dark skin around the neck, armpits, groin or any other body location such as the elbows. Some people perceive acanthosis nigricans as skin of a person with poor personal hygiene, says Dr Sekgoma. However, this has nothing to do with hygiene but rather a sign of insulin resistance. It is a well characterised sign of Prediabetes. Its best to consult a physician and dietician if this sign is present on your skin.

Diabetic dermopathy

Patients with diabetic dermopathy present as multiple brown coloured circular spots on the legs which often are overlooked by patients and doctors as age spots. this results from damage from the small blood vessel by Diabetes.

Dr Sekgoma gives the following recommendations to

prevent skin issues:

l Ensure that diabetes is properly managed by a Physician or Endocrinologist

l Consult a dermatologist once a year to assess and evaluate your skin

l Consult a dietician

l Take luke warms baths and wipe skin areas such as under the breasts, armpits, groin, and between the fingers and toes with a dry clean face cloth after bathing

l Moisturise the skin

l Get any wounds or cuts treated immediately

l Foot care- inspection of feet for open wounds and wear appropriate shoes

In conclusion, there are many more skin signs that a dermatologist can pick during an examination. While the skin signs of diabetes are generally harmless they should never be ignored. It is best to consult a dermatologist once a year to carefully assess and evaluate the skin.

Dr Neo Sekgoma

Specialist Dermatologist

BMedSci MBBS (UWI) FCDerm

(SA) MMed (Pretoria)