Diabetes Self-Management Articles

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Diabetes and Your Skin
Protecting Your Outermost Layer

by May Leveriza-Oh, MD

Impetigo may improve on its own, or it may become chronic and widespread. The use of oral antibiotic medicine, coupled with topical antibiotics such as bacitracin, antibacterial soaps, and good hygiene, is typically sufficient to clear the infection within a week. Ecthyma is usually treated the same way but for a longer period of time; generally, antibiotics are taken for 10–14 days. Since lesions (areas of damaged tissue) are deeper in ecthyma, they usually take a longer time to close, and they may heal with some degree of scarring.

Folliculitis, furunculosis, and carbuncles. Folliculitis, furunculosis, and carbuncles are all infections that arise in the hair follicles. Sweat and other conditions that cause moisture on the skin (such as high temperatures and humid weather), the shaving of hairy regions such as the underarms and legs, and the blockage of hairy areas by clothing, bandages, or casts or by lying or sitting in one spot for a long period of time can all increase the risk of an infection in the hair follicles.

Folliculitis is inflammation of the hair follicle that is characterized by the formation of a pustule (a small pimple or blister containing pus) or a group of pustules. Furunculosis is distinguished by the development of furuncles — deep, red, hot, tender nodules — that may develop from the pustules found in folliculitis. The nodules usually enlarge, become painful, and rupture after several days, forming abscesses (swollen areas containing pus). Furuncles generally occur on the neck, face, underarms, and buttocks. A carbuncle is a larger, painful, more serious lesion with a deeper base, generally occurring at the nape of the neck, on the back, or on the thighs. The area is red, swollen, and covered in pustules. Fever and a feeling of illness may also occur with a carbuncle.

The chances of getting folliculitis may be lessened by using clean or new razors to shave, exposing areas of the skin that are typically covered, such as the back, to the air, and wearing loose, cool clothing. Lesions usually improve on their own, but they heal faster with the use of antibiotic washes and creams. Simple furunculosis is treated by the local application of antibiotic creams and warm, moist compresses, which relieve discomfort and promote drainage. A carbuncle or furuncle with a significant amount of redness or swelling or an associated fever should be treated with a systemic antibiotic (one that affects the entire body), since one of the risks of these lesions is an infection of the bloodstream. This can spread bacterial infection to many of the body’s organs, including the heart, brain, and kidneys.

When the lesions are large, painful, and fluctuant (they can be shifted and compressed), draining them via surgery is usually the best option. In these cases, the person should receive antibiotics until all evidence of inflammation has disappeared. After the lesion is drained, the area should be covered with a thin layer of antibiotic ointment and a sterile dressing.

Cellulitis and gangrene. Two of the more serious and complicated bacterial infections that occur in people with diabetes include cellulitis and infectious gangrene. Cellulitis is an infection that spreads through the deeper layers of the skin as well as the fat layer directly underneath the skin. People who develop cellulitis usually have an open wound that acts as an entry point for bacteria, although occasionally, the skin infection originates from a bacterial infection of the blood. Areas infected by cellulitis are typically red, warm, painful, and swollen. The lesions feel hard to the touch, and there is no clear line between skin that is infected and skin that isn’t infected. This condition usually affects the face and extremities, and sometimes it also occurs on the trunk. The legs are affected three times more often than the arms.

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