Diabetes and

the Skin

From Head to Toe

SCOTT MURRAY MD FRCP

Established or probable

association

Necrobiosis lipoidica diabeticorum (NLD)

Diabetic dermopathy

Diabetic bullae

Acanthosis nigricans

Scleredema diabeticorum

Limited joint mobility and waxy skin syndrome

Partial lipodystrophy

Eruptive xanthomas

Carotenemia

Pruritus

Possible association

Disseminated granuloma annulare

Vitiligo

Increased susceptibility to infections:

Candida albicans

Staphylococcus aureus

Pseudomonas aeruginosa

Damaged circulation

Leg ulcers

Cold feet

Necrosis

Damaged nerves

Trauma

Neuropathic leg ulcers

Necrobiosis Lipoidica Diabeticorum Also caused by changes in blood vessels

Similar to Diabetic Dermopathy but the spots are

fewer in number and larger and deeper

Can be itchy, painful, and difficult to treat1

Diabetic Dermopathy

Caused by changes in the small blood vessels

Light brown, scaly, atrophic patches

Usually occur on the shins

Lesions do not itch, hurt, or

open up

Diabetic Blisters (Bullosis

Diabeticorum)

Most commonly on the backs of fingers, hands,

toes, feet, and sometimes on legs or forearms

Look like burn blisters

Acanthosis Nigricans

Hyperpigmented, velvety, hypertrophic plaques

Most commonly found in armpits, neck, and

groin2

Acanthosis nigricans

scleredema

Digital Sclerosis Tight, thick, waxy skin most commonly on the back of the hand

Finger joints can become stiff

Lipodystrophy- loss of fat

Eruptive Xanthomatosis

Firm, yellow, pea-like enlargements in the skin

Most often on backs of hands, feet, arms, legs,

and buttocks

Common Skin Problems Cont.

ITCHY!!!!!!!!!!! Often a result of yeast

infection, dry skin, and/

or poor circulation

Granuloma Annulare

Disseminated

Vitilgo

Common Diabetic Skin

Problems

Bacterial infections Cellulitis

Folliculitis

Common Diabetic Skin Problems

cont.

Fungal Infections Tinea pedis (athlete’s foot)

Tinea cruris (jock itch)

Vaginal yeast infections

Onychomycosis (fungal infection of the nails)

PERLECHE

Foot problems

The feet can be affected by: Decreased blood supply

poor healing

Nerve damage

loss of feeling

High Blood Sugar levels

decreased healing

increased infections

Peripheral Vascular Disease

Diabetics are more prone to

develop atherosclerosis, which

can result in peripheral

vascular disease

Claudication

Delayed healing

Cold, pale, hairless legs

and feet

Thick nails

Ulcers

Gangrene

Diabetic Foot Ulcers

Diabetic Neuropathy

Infections

infections In diabetics-worse than they

appear!!!!

Assessment and awareness Regular assessment of feet is important to check for:

Sense of feeling and pulses in the feet

Foot problems/deformities or past history of foot ulcer

If foot problems are present feet referral to a podiatrist is recommended.

Beware of Loss of feeling

Poor blood supply

Past history of foot ulcer

Identification of a problem

Daily inspection of the feet note: Broken skin

Redness

Swelling

Corns/callus

Black/blue areas

Report to nurse/GP or podiatrist

for assessment if you detect any

of these problems

Diabetic Foot Exam

Check feet daily for sores, ulcers, cuts

Wear broad, flat shoes that fit properly

Check shoes for foreign objects before putting

them on

Skin Care

Examine feet for sores, cuts, blisters, etc.

Moisturize skin and use gentle soaps when

showering

Treat cuts/breaks in skin

Treat fungal infections of the feet

Keep skin dry and clean

Prevention and Treatment of Skin

Conditions

Good News:

The majority of the

skin conditions

discussed can be

prevented or treated

by good blood glucose

control!!!

Prevention is better

than cure!

Prevention and early

identification of foot

problems can

prevent foot ulcers

and amputation