Peripheral vascular disease is another factor that can contribute to the formation of foot ulcers in people with diabetes. Because of the decreased blood circulation to the feet in this condition, there is an impaired delivery of oxygen, nutrients, and antibiotics. Therefore, wounds tend not to heal well and to become infected.
Foot ulcers warrant immediate attention and treatment. The physician will need to determine how deep and infected the ulcer is. He may take an x-ray of the foot to check whether infection has spread to the bone. Treatment for a foot ulcer may include oral or intravenous antibiotics to control the infection, as well as dressings and salves with lubricating, protective, antibiotic, or cleansing properties. Taking care of the ulcer and following up with health-care providers is very important for preventing complications that could eventually lead to an amputation.
Necrobiosis lipoidica diabeticorum. This condition occurs in about 0.3% of people with diabetes and is three times more common in women than in men. Lesions tend to form on the fronts and sides of the lower legs, although they may also occur on the face, arms, and trunk. The typical lesion begins as a tiny, dusky red, elevated nodule with a defined border. It gradually enlarges, becoming irregular in shape. It may then become depressed and turn a brownish-yellow color, except for the border, which remains red. Affected areas may lack sensation because of the destruction of some nerves and nerve endings.
The course of this condition is usually chronic and recurrent. Although topical steroids may halt progression of active lesions, it is very difficult to completely cure the affected areas. Untreated lesions can readily deteriorate to form shallow, painful ulcers. Unfortunately, not even the normalization of blood glucose levels is sufficient to control this skin condition in many cases.
Digital sclerosis and scleredema audoltorum. Digital sclerosis is a condition in which the skin on the hands becomes thickened and waxy and may develop multiple, pebble-like growths. Scleredema audoltorum is a similar condition that affects the back and sides of the neck, with the possibility of painless swelling spreading to the face, shoulders, and upper torso.
Although there is no effective treatment for these conditions, they generally resolve on their own within six months to two years.
Saving your skin
To protect your skin and help prevent skin ailments from developing, observe good hygiene. Bathe regularly and wash your hands often. Keep areas of the skin that are susceptible to infections, such as the underarms, groin, area under the breasts, neck, web spaces of the feet and hands, and inner thighs clean and dry. If necessary, use antichafing powders or creams and choose proper clothing that allows air to circulate. After bathing, dry these areas well to prevent infections from beginning. People who live in hot, humid areas should change their clothing once it becomes wet from perspiration.
Be sure to use mild or hypoallergenic varieties of products that come in contact with the skin, such as soaps, lotions, washes, and creams. Products with additives such as fragrances or coloring can irritate the skin or cause an allergic reaction.
Also keep an eye out for skin reactions that arise as a result of allergies to medicines. Reactions to oral drugs may take the form of itching, rashes, or wheals, while reactions to insulin may appear as bumps, rashes, or depressions in the areas where insulin is injected. If you suspect you are allergic to one of your diabetes drugs, inform your health-care provider.