Diabetes Self-Management Articles

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Diabetes and Your Skin
Protecting Your Outermost Layer

by May Leveriza-Oh, MD

There is no cure for this condition, but it may improve with weight loss, topical bleaches, or a class of drugs known as keratolytics.

Vitiligo. Vitiligo is a skin disorder that causes white spots or large areas of depigmentation to occur on various areas of the body. About 30% of people with vitiligo have a family history of the condition, and it is more common in people with Type 1 diabetes than Type 2 diabetes. Vitiligo progresses slowly over the years, commonly affecting the backs of the hands, the face, and body folds such as the underarms and groin.

Treatment of vitiligo is necessary only in people who have severe cases or who are considerably distressed by the condition. Treatment involves the use of steroids or chemical agents called psoralens that are either placed directly on the skin or taken orally. The most popular treatment, known as PUVA, uses oral psoralens in combination with phototherapy sessions, in which the person is exposed to ultraviolet light, specifically ultraviolet A.

Granuloma annulare. A common skin disorder of unknown cause, granuloma annulare manifests as skin-colored or pinkish groups of bumps, or papules, that may be arranged in rings. There are several subtypes of granuloma annulare; the one associated with diabetes is called disseminated, or generalized, granuloma annulare, in which lesions are widespread over the body. The use of steroid creams or ointments or steroid injections is sometimes used to treat lesions. Most, however, disappear on their own within two years.

Diabetes-related skin conditions
The following skin conditions occur almost exclusively in people who have diabetes.

Diabetic dermopathy. This common skin condition is characterized by depressed, irregularly round or oval, light brown, shallow lesions. Lesions may vary in number from few to many and are usually found on both legs but are not symmetrically distributed. Because these lesions do not itch, hurt, or open up, they are often overlooked and not reported to the health-care provider.

Diabetic blisters (bullosis diabeticorum). This is an uncommon condition in which blisters occur on the hands and feet and sometimes also the legs and forearms. The blisters are unrelated to trauma or infection; they develop spontaneously and may become quite large. However, they are usually not painful and typically heal without scarring in several weeks.

Foot ulcers. Foot ulcers are a serious problem that can ultimately lead to amputation if left untreated. Each year, about 2% to 3% of people with diabetes develop a foot ulcer. Approximately 15% of people with diabetes develop a foot ulcer at some point in their lifetime.

Foot ulcers are erosions on the skin of the feet. Some affect just the outermost layers of skin, while others extend to deeper tissues. Ulcers often begin as a result of minor trauma, such as irritation from ill-fitting shoes that goes unnoticed or untreated. The most common locations for ulcers to develop are the weight-bearing areas of the foot such as the heel and the ball of the foot and sites subject to pressure such as the toes or ankles.

A number of factors make people with diabetes more likely to develop foot ulcers than those without diabetes. Neuropathy is one risk factor. Almost all people with diabetes who develop typical foot ulcers have neuropathy that affects their motor, sensory, or autonomic nerves. Neuropathy in the motor nerves causes weakness, thinning, and limitation in the movement of certain muscles in the foot, leading to deformities in the normal foot shape such as atypically high arches, claw toes (all toes except the big toe bend toward the floor) and hammer toes (the longest toe bends toward the floor at the middle toe joint). Neuropathy of the sensory nerves results in loss of protective sensation to pain, pressure, and heat. People with sensory neuropathy may therefore not be aware of cuts, abrasions, and calluses that can lead to ulcers. Depending on the amount of sensory neuropathy, people may even be unaware of major traumas to their feet, such as occur from stepping on pins, glass, and other sharp objects. Neuropathy of the autonomic nerves can lead to warm, excessively dry feet that are prone to skin damage.

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