Following is a list of the more common skin disorders in those with diabetes with a brief description and possible treatment options:

Acanthosis nigricans: a velvety thickening of the skin, especially in theneck, groin and underarms. Seen most commonly in overweight diabetics.

Treatment: Difficult to treat, can be improved with prescription topical moisturizers that also help slough the skin. Weight loss and improved control of diabetes is also helpful.

Allergy to insulin: allergies are more common to insulin from cows thanthe porcine or human insulins. Allergy can appear as a “drug rash” with redness and itchiness over the trunk, arms and legs.

Treatment: change to different form of insulin.

Diabetic dermopathy: brown, thinned irregularly shaped patches usually on the shins. Individual lesions gradually disappear over 1-2 years, only to be replaced with new ones.  May be slightly itchy. This entity is more common in men than women, and usually occurs because of long periods of uncontrolled diabetes when there is evidence of significant changes in other organ systems as well.

Treatment: Improved control of blood sugar

Granuloma annulare: multiple reddish ring-like, sometimes itchy rash on the arms, legs, abdomen, and back. Relatively uncommon.

Treatment: may require injection of corticosteroids into individual lesions,or topical steroids to affected areas.

Infections: more common in diabetes that is not well controlled.

A)     Most commonly, candidiasis of any part of the skin (caused by a yeast called Candida albicans). In the mouth it looks whitish, on the skin it has a very characteristic “beefy red” color. May be mildly itchy or painful. Looks worse than it feels.

B)      Fungal infections of the skin and nails. It is very important ttreat these infections since they may cause tiny breaks in the skin, which then become areas where bacteria can enter and cause more serious internal infections.

C)     Impetigo- a highly contagious bacterial infection, most commonly on the face. This is usually a red area with a “honey-colored” crust overlying it.

Treatment: Topical or oral antifungals or antibiotics, depending on the type of infection.

Diabetic ulcers: decreased sensation, especially of the lower extremities is the most important cause. There are also changes in blood vessels, especially in individuals in whom diabetes has been present for over 20 years that decreases the ability of the legs to tolerate even moderate excesses of heat or cold. The most important preventive techniques include meticulous attention to skin care. This means daily foot inspection for any breaks in the skin or small ulcers, comfortable shoes (ill-fitting shoes are the most common cause of foot ulcers), avoid walking barefoot. See your doctor [JS2] immediately for any calluses, blisters, “ingrown” toenails, or “athletes foot.” You may need to be referred to a dermatolo- gist or podiatrist for further care of these problems.

Lipodystrophy: changes in patterns of fat distribution. Occurs in areas of insulin injections.

Treatment: vary sites of injections.

Necrobiosis lipoidica: may not be more common than in the general population. Occurs as brownish-yellow, thinned patches of skin, most commonly on the shins, but can occur anywhere on the body. Three times more common in women than in men.

Treatment: some have tried low dose aspirin or blood thinners; others have tried injecting or applying corticosteroids to the affected areas.

Neuropathy of the skin: generally occurs after long periods of uncontrolled diabetes, where there is decreased sensation of the extremities. Care must be taken to avoid trauma, which can lead to poorly healing ulcers and other complications.

Rubeosis: a chronic, flushed appearance of the face, neck, and sometimes extremities. Treatment: Improved diabetic control is essential. Avoid caffeine, alcohol.

Scleredema adultorum: painless thickening and swelling that begins on the back of the neck. This can spread to the back, abdomen, arms and hands. Occurs mainly in obese diabetic individuals. Much more common in type II diabetes. Many treatments have been tried, none are curative. Weight loss and good control of diabetes may be helpful.

Thickened skin, Stiff joints, and Scleroderma-like syndrome: tight, thickened and waxy skin over the back of the hands. A possibly related change is stiffness of the joints of the fingers. Studies have shown? That for every unit increase in average hgbA1C, there is approximately a 46% increase in the risk of joint problems.

Treatment: Improved diabetic control.

Vitiligo: white spots on the skin, usually beginning around the eyes or mouth, then spreading to the hands and any part of the body. Due to antibodies to melanin in the skin. Since melanin provides the skin with its color, destruction of melanin leads to areas that appear white.

Treatment: start with low dose topical steroids for a few months. Other treatments, such as light therapy, aimed at suppressing the immune system may also be tried.

Xanthomatosis: high cholesterol and triglyceride levels are more common in individuals with diabetes, even those with only mild elevations of blood glucose. Xanthomas are usually multiple small reddish-yellow nodules that tend to appear in crops over the arms, legs and buttocks and are a result of the increased levels of cholesterol and triglycerides?

Treatment: rapid regression occurs when diabetes is brought under control.

Yellow skin: elevated levels of carotene in the blood can lead to a yellowish/orange discoloration of the skin. This may be due to the way carotene is digested by the liver.

Treatment: Decrease intake of foods rich in carotene- e.g. carrots, oranges.

Good control of diabetes is essential in minimizing any manifestation ofdiabetes in any given organ system, including the skin. Proper care of the skin also requires avoidance of breaks in the skin. Dry skin, even just a little bit of dry skin, can be very itchy. Itches require scratching; Scratching can lead to breaks in the skin, which then become portals of entry for bacteria. Bacteria can then spread through the blood and cause either local or widespread infection. This means extra-special attention to the skin, especially in the winter, is essential:

1. No long hot showers/baths: maximum of 10-15 minutes with   warm, not hot, water;

2. Use mild soaps or cleansers;