Are skin conditions linked to type 2 diabetes?

Skin complications usually occur when blood sugar levels are too high, and they are often the first visible sign of diabetes.

An estimated one-third of people with diabetes experience skin conditions either related to or influenced by the condition.

Medication options exist, but managing blood sugars is normally the best prevention and treatment option.

Type 2 diabetes and skin health

 

When blood sugar levels are too high for too long, several changes take place in the body that affect skin health.

Blood sugar is removed from the body through the urine. When there is excess blood sugar, the rate of urination increases, which can cause dehydration and dry skin.

High blood sugar levels can also lead to inflammation, which over time dulls or overstimulates the immune response.

High blood sugar levels can also cause nerve and blood vessel damage, reducing circulation. Poor blood flow can alter the skin’s structure, especially its collagen. Without healthy collagen networks, the skin can become stiff and in some cases brittle. Collagen is also necessary for proper wound healing.

Several skin conditions are associated with high or uncontrolled blood sugar levels.

While most skin complications associated with diabetes are harmless, the symptoms of some can be painful, persistent, and they may require medical attention.

The best and easiest treatment option for most diabetes-related skin conditions is managing blood sugar levels. In severe cases, however, oral steroids or medicated creams may be used.

Common skin conditions associated with type 2 diabetes include the following:

Acanthosis nigricans

This condition is marked by a darkened band of velvety skin, especially in the folds near the groin, back of the neck, or armpits. Lesions can be a sign of prediabetes.

Acanthosis nigricans occurs in as many as 74 percent of obese people with diabetes. Losing weight is the best way to reduce the risk of developing the condition.

Psoriasis

 

People who have psoriasis often develop red patches on their skin that may be itchy and scaly. Some people may also experience changes in their nails. Some people who have skin psoriasis may also develop psoriatic arthritis, which includes severe joint pains.

Treatment options for psoriasis include lifestyle changes, cortisone creams and ointments, good blood sugar management, weight control, and often oral or injectable biologic medications.

People with type 2 diabetes are considered two times more likely to develop psoriasis than those without diabetes.

Sclerederma diabeticorum

This condition is marked by skin thickenings that typically appear on the upper back and back of the neck. Scleroderma is a rare condition that generally affects those who are overweight.

Treatments include oral medications such as cyclosporine. Sometimes specialized light therapy may be used.

Limited joint mobility and waxy skin

People who have this condition may develop tight, thick, waxy-looking skin on their skin, hands, and digits, which can cause joint stiffness and even contraction of tendons.

The best way for people with diabetes to prevent this complication is by maintaining their blood sugar levels.

Diabetic bullae or blisters

Although rare, this condition is almost always an indication of diabetes. People who get this condition develop irregular shaped blister-like sores that appear randomly across their feet and hands. The blisters are typically 0.5 to 17 centimeters (cm) in size, painless, and occur alone or in patches.

The only real treatment option is good blood sugar management. Those with bullae lesions should avoid breaking the contained sore to prevent infection. They usually heal without scarring, but if complications develop, sometimes amputation may be necessary.

Diabetic dermopathy or shin spots

This condition is marked by circular, reddish, or light-brown patches that usually appear on the shins or other bony parts of the body. Patches are also usually indented and scaly.

Around 39 percent of those with type 2 diabetes develop diabetic dermopathy.

The condition is caused by nerve and blood vessel damage, in particular small blood vessel changes.

As the condition impacts areas of the body with less protective muscle and fat, lesions may reflect an increased response to injury.

Diabetic dermopathy lesions are harmless and treatment is not usually required.

Diabetic ulcers

 

Sometimes insignificant wounds can become open sores called diabetic ulcers.

Diabetic ulcers can occur anywhere on the skin but most often appear on the feet.

An estimated 15 percent of people with diabetes experience foot ulcers.

Xanthelasma

Marked by scaly, yellow lesions that appear on and near the eyelids, this condition may be related to high blood sugar and fat levels. However, they can occur in people without any fat or sugar issues.

Treatment for xanthelasma includes dietary changes and lipid-reducing medications.

Eruptive xanthomas

Marked by variably itchy outbreaks of crops of bumps with a reddish-brown to yellowish-orange color.

Lesions can form anywhere on the body but most often appear on the thighs, buttocks, and crooks of the elbows and knees.

Skin tags

Skin tags are soft, skin-colored growths that hang from the skin. Skin tags are extremely common in the general population. In excess, however, they can signal raised or uncontrolled blood sugar levels.

Skin tags favor areas such as the underarms, neck, under the breasts, and the folds of the groin.

Necrobiosis lipoidica diabeticorum (NLD)

Lesions usually begin as small, firm, raised bumps that progress to larger plaques of waxy, hard, depressed, yellow to reddish-brown skin.

Plaques are usually painless, and surrounding skin appears very pale and shiny in comparison. Lesions often become waxy and develop a purple border over time. While harmless, NLD can cause complications, such as scarring.

The condition cycles between active and dormant periods, based in part on blood sugar management. If a person experiences dramatic, relentless patches, it may be a sign that the current treatment plans for their diabetes are not working.

Treatments for NLD can include topical and oral medications.

Granuloma annulare

Marked by raised, reddish, or skin-colored bumps that spread outwards in a ring, lesions often occur on the hands, fingers, and forearms. They can be isolated or numerous on the body.

Researchers are not clear on whether or how diabetes causes granuloma annulare. The lesions are harmless, although medications are available to treat bothersome or persistent cases.

Skin conditions influenced by type 2 diabetes

People with type 2 diabetes tend to experience more frequent, severe bacterial and fungal infections than those without diabetes. Those with diabetes also tend to experience more frequent, severe allergic reactions.

Bacterial infections usually appear as inflamed, pus-filled, painful, red sores and are most commonly caused by Staphyloccous bacteria. Antibiotics and proper blood sugar management are usually enough to prevent bacterial infections from becoming life-threatening.

After a few days, most bacterial sores will release pus and then begin to heal. Sores that cannot drain on their own, or are extremely painful or persistent, may need to be opened in a doctor’s office.

 

Common bacterial infections for people with type 2 diabetes include:

• boils – these lesions begin as sore spots that become inflamed nodules 2 to 3 cm in diameter
• styes, an infection of the eyelid gland
• nail infections
• infection of the hair follicles
• carbuncles – these lesions appear as firm, tender lumps that follow groups of connected boils

Fungal infections usually cause red rashes bordered by scaly skin and sometimes small blisters. Fungi require moisture to thrive, so infections tend to occur in warm, wet folds of skin, though they can be found anywhere on the body.

Commonly affected areas include between the fingers and toes, the armpits, and the groin.

Treatment should be sought to avoid prolonged or frequent infections. Other common infections associated with type 2 diabetes include yeast infections, such as thrush.

Athlete’s foot is a common type of fungal infection, typically appearing as either scaly patches between toes, recurring blisters, or powdery scaling across the soles.

Cases of athlete’s foot may be caused by contact with an affected person through shared footwear or in wet environments, such as showers.

Ringworm is another name for a fungal infection. Ringworm is not actually caused by a worm but gets its name from the ring-like rash that develops.

The best way to reduce the risk, severity, and frequency of all diabetes-related skin conditions is to maintain healthy blood sugar levels.

Diet, exercise, losing weight, and medications can help reduce blood sugar levels, decreasing the risk of skin complications. Following some personal care rules can also help prevent these complications.

Skin care tips include:

• Avoiding long or hot baths and showers. Saunas and hot tubs are also usually best avoided.
• Avoiding certain bath products that can dry out or irritate the skin. This includes most regular and scented soaps, bath oils, and bubble bath formulas.
• Using mild shampoos, conditioners, and body washes.
• Keeping skin as clean and dry as possible.
• Preventing overly dry skin by keeping hydrated and using moisturizers.
• Avoiding excess moisturizer between the toes to discourage fungal growth.
• Using a humidifier and bathing less frequently when the weather is dry.
• Avoiding feminine hygiene sprays.
• Avoiding scratching or rubbing infections, rashes, and sores.
• Treating cuts immediately and monitoring their healing progress.
• Addressing persistent skin problems. People should see a dermatologist if any skin conditions become bothersome or persistent.

People with diabetes should also check their feet for skin alterations, sores, and other changes daily. Well-fitting, comfortable shoes can help improve foot circulation and prevent or lessen the impact of other conditions.