Diabetes mellitus causes a variety of manifestations in the skin as it does in many other organs in the body. Some of the skin diseases associated with diabetes, like the diabetic dermopathy and diabetic bulla are seen only in diabetic patients. Others, like necrobiosis lipoidica are seen in other conditions also, but majority of patients with these conditions have diabetes. Hence these skin conditions are considered as cutaneous markers of diabetes.
How is Skin Affected in Diabetes?
Nearly half of diabetic patients have some type of dermatologic manifestations. With time, though, the skin of all diabetic patients is affected in some form or another. In many patients, skin manifestations should alert the physicians to the diagnosis of diabetes. For example, candidal balanitis, diabetic bullae, diabetic dermopathy, necrobiosis lipoidica diabeticorum, and the scleroderma-like syndrome of waxy skin with limited joint mobility should arouse the suspicion of underlying diabetes.
There are many patho-physiological mechanisms through which diabetes can cause skin diseases. These include structural and functional changes induced within the skin through the adverse effects of diabetes on the blood vessels, the collagen in the dermis, the metabolic changes and the neuropathic changes affecting the nerve supply to the skin.
How Does Diabetes Cause Skin Disease?
Hyperglycemia (increased sugar levels in the blood) causes what is known as a non-enzymatic glycosylation of proteins resulting in accumulation of advanced glycation end-products (AGE) within the tissues of the body, including the skin. AGE is responsible for the collage degeneration in the dermis of the skin as well as in the blood vessels and other tissues. This, in combination with other structural, metabolic and nerve damage caused by diabetes predisposes the skin to a variety of manifestations.
Diabetes reduces the body’s resistance to infectious germs and the skin becomes more prone for bacterial, fungal and viral infections if the blood sugar levels are not kept under control.
How Do You Classify the Dermatological Manifestations of Diabetes?
Depending upon their association with diabetes the cutaneous manifestations of diabetes are categorized into 4 major groups:
- Skin diseases usually seen in diabetes and very rarely in other conditions or the cutaneous markers of diabetes, such as necrobiosis lipoidica, diabetic dermopathy, and diabetic bullae. Acanthosis nigricans and skin tags are common in obese diabetics.
- Cutaneous infections commonly seen in diabetics, especially recurrent boils and yeast infections. Herpes zoster (shingles) and post herpetic neuralgia are seen in a higher frequency in diabetics than in the general population.
- Dermatological manifestations of diabetic complications, such as neuropathic foot ulcers, and
- Treatment related skin reactions. Both insulin and oral antidiabetic medications can cause skin reactions ranging from localized bumps at the injection site to generalized red eruptions and, rarely, even anaphylactic shock.
How to Treat Skin Diseases in Diabetes?
Most of the common skin diseases prevalent amongst the diabetics can be prevented or their progression arrested with adequate blood sugar control in the diabetics. Each of these skin diseases has specific options. Infections are treated with appropriate antibiotics and topical skin care.
Neuropathic complications are handled through specialized foot and wound care, as these may further worsen the patient’s condition and even lead to extension of the infection culminating in amputation of the affected limb.
If a medication is suspected to cause skin reaction in diabetics, the medication is discontinued and an alternate medication is prescribed.
Source
- AA Kalus, AJ Chien, JE Olerud. Diabetes Mellitus in Fitzpatrick’s Dermatology in General Medicine, 7th Ed, 2008.
- Tammie Ferringer & Fred Miller III. Cutaneous Manifestations of Diabetes Mellitus .Dermatol Clin 20 (2002) 483-492.
Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, Dr. Hanish Babu, MD or Suite101 will not be responsible for any consequences. The images provided are for illustration purpose only.
Hanish Babu - Dr.Hanish Babu, MD is a dermatologist and a feature writer on Suite101.com with more than 200 articles related to skin diseases on the ...
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