The air outside is cold and dry. Inside, fires and furnaces bake away what little moisture is left in the atmosphere. Break out the lip balm and hand lotion. It’s the dry, itchy skin and chapped lips time of the year — winter in Diabetes Land. What can you do to keep dry skin in check this time of year? How bad does dry skin have to get before you need to see your doctor? And why do we seem to have more problems with dry skin than everyone else?
John Anthony, MD, a dermatologist for the Cleveland Clinic, thinks that there’s something lurking in the skin or DNA of people with diabetes that makes them prone to dry skin. According to him, research shows that fully 26 percent of people with diabetes suffer various “problems with dry skin,” although he states, “I don’t think we understand why,” adding, “it’s a bit of a mystery.”
But to Lauren Levy, MD, of the Yale School of Medicine, an expert on skin conditions related to diabetes, it’s no mystery at all. For her, it’s simple. She thinks dry skin is 100 percent caused by hyperglycemia — elevated blood sugar in uncontrolled diabetes — saying matter-of-factly, “It dehydrates the skin.”
Meanwhile, in the trenches, certified diabetes educator (CDE) Erin Kelly, who works for Harvard’s Joslin Diabetes Center, isn’t so sure. She says, “We see dry skin across the board with all patients. Rarely would I assert that the dry skin is caused by hyperglycemia; it’s too hard to correlate in the presence of other factors.”
So take your pick, but regardless of the cause of the dry, itchy hands and cracked lips, you need to fix the problem, both for comfort and, because left alone, dry skin can become a dangerous ticking time bomb for people with diabetes.
While there doesn’t seem to be much agreement on the causes of dry skin in people with diabetes, the experts we talked to are in universal agreement on how to stay ahead of it. Their number one recommendation is to use fragrance-free skin care products. In Levy’s words, “Use Dove instead of Irish Spring. Irish Spring may smell great, but it dries out the skin.” Of course, Levy emphasizes the importance of getting and keeping blood sugar in control as the first step toward preventing dry skin issues, but after that, she advises avoiding hot showers, another point that all our experts agree on.
Anthony says patients should also avoid what he calls “over-bathing,” noting that many people with dry skin will bathe two to three times a day, partly because it “feels good,” and partly because many people assume this will help moisturize the skin. But, in fact, frequent bathing actually dries out the skin more, according to Anthony. He also advises patients not to scrub too hard when bathing, to blot dry, and then to apply cream or lotion to damp skin.
When it comes to creams and moisturizers, Anthony recommends products with dimethicone to lock moisture in, ceramide fats to help restore the barrier function of skin, and humectants to draw moisture up into the skin from lower tissue levels. His prescription for preventing dry skin is to use creams twice a day, adding that there’s a lot of benefit to applying a cream “right after a shower.” In the shower, he prefers his patients to use liquid bath gels rather than traditional soap because “a pure soap may not be gentle on the skin.”
In addition to direct skin treatments, Kelly recommends that people with diabetes consider using a humidifier in their homes during the winter months “to add some moisture back into the air while the heat is on.”
All of our experts agree: There’s nothing wrong with the “diabetes-branded” skin products, but they aren’t necessary. Over-the-counter products are just as effective as long as they are fragrance-free.
Levy says that diabetes-branded products aren’t superior, but “if the price is right, go for it.” Like Anthony, she advises patients to look for products with ceramides. She also notes that dry skin isn’t just a winter issue, and that people with diabetes need to be proactive year-round to take care of their skin. “I give this advice 100 times a day with patients,” she says.
Skin is an important barrier that protects the body from infection. Anthony says that people with diabetes “really can’t afford to have breaks in the skin. Having an intact barrier is really important.” Kelly says, “We think about dry skin and diabetes because dry skin can create openings in skin integrity that are a potential source of infection. With diabetes, the sugar in your blood could act as food for the infection and make it harder to heal.”
What are the warning signs that your dry skin is about to turn from bad to worse?
Kelly tells her patients to see a dermatologist or podiatrist “if you have severe cracks in your skin.” She also urges her patients to check their skin daily for “signs of infections, irritation, skin breakdown, or worsening of skin condition.”
Levy says that if dry skin doesn’t respond to simple treatments, “seek a consultation with a dermatologist, as inflammatory diseases is a risk.” She also urges expert help if a rash erupts.
“At some point, dry skin leads to inflammation, which can lead to breaks, then infection,” Anthony warns.
Suzanne Ghiloni, CDE, who works with Kelly at Harvard, says, “My patients who wear devices — pumps and continuous glucose monitors — seem to have a special need to avoid dry or irritated skin because it impacts the adherence and comfort of the adhesive on their skin. This is always more of a problem in the winter.” Her recipe nicely sums up the advice of all of our experts: “I ask them to practice good skin hygiene, that is, warm — not hot — water for baths and showers, gentle soaps like Dove or Cetaphil, and regularly moisturizing the skin with non-medicated, non-perfumed lotions.”
Want to learn more about diabetes and skin care? Read “Diabetes and Your Skin: Protecting Your Outermost Layer” and “Summertime Skin Care,” then test your knowledge with our skin-care quiz.
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