Diabetes can affect the entire body, including your skin.
Got an unsightly and itchy rash or bump that is just not going away? It could be a result of diabetes, a chronic metabolic disease that badly affects major organs of the body, including your skin.
Yes, you heard that right – diabetes can be the key cause of the skin rashes you have been experiencing lately. A number of skin lesions are related to type 1 or type 2 diabetes mellitus, consumption of specific antidiabetic drugs, certain metabolic and endocrine disorders (that cause secondary diabetes mellitus) and specific chronic complications of the disorder.
| Diabetes increases blood sugar levels, leading to glaucoma, high blood pressure and even severe disorders in your heart. Moreover, diabetes, the chronic metabolic disorder can leave it marks on your largest organ “skin”. |
| TriviaAccording to the American Diabetes Association, “around 33% of people with diabetes develop a related skin aliment”. In fact, a chronic skin rash, blister or fungal infection is often the 1st clue to the disease. |
As many as one-third people suffering from diabetes will have skin rashes at some time in their lives. The outbreaks in the skin can be as benign as a small yell rashes or dry skin (resulting from high cholesterol) to brown spots (indicating insulin resistance), boils and severe infections that could take you to hospital. Fortunately, most skin rashes diabetes can be treated if caught early.
The key is to get the treatment early – before they grow into a serious problem,” suggests Debra Jaliman, M.D., F.A.A.D., assistant clinical professor of dermatology at Mount Sinai School of Medicine in New York.
Classification of Skin Lesions in Diabetes Mellitus
There is a significant uncertainty about the pathogenesis of the myriad cutaneous conditions affecting diabetic patients in no limited part because of our poor understanding of the metabolic basis of diabetes itself.
There is as such no strict classification of skin conditions associated with diabetes; thus, classifying them under the following categories will provide us an idea about different kinds of skin lesions that may occur if a person has diabetes. So, a person would know what all dermatologic conditions can develop in a diabetic.
A) Skin lesions associated with but not limited for diabetes mellitus
- Necrobiosis lipoidica diabteticorum
- Pruritus
- Diabetic dermopathy
- Diabetic bullae
B) Dermatoses common in diabetes mellitus
- Lichen planus
- Perforating dermatosis
- Vitiligo
- Psoriasis
- Kaposi’s sarcoma
- Eruptive xanthomas
- Bullous pemphigoid
- Dermatitis herpetiformis
Different types of Skin Lesions in Diabetes Miletus in Detail
A) Skin lesions associated with but not limited for diabetes mellitus
Necrobiosis lipoidica diabteticorum
It develops in 0.3% to 1.6% of diabetic patients
The skin infection is very rare, developing in only 7% of diabetic patients. The somewhat asymptomatic skin lesions are 3-times more common in females than males. It is one of the cutaneous markers of diabetes. At the time of diagnosis around will develop the disease in 10% of people will develop diabetes within 5-years or suffer abnormal glucose tolerance or have history of the disorder in at least one parent. The lesion can pop up at any age, but is more common in young adults at a mean age of 34 years.
In insulin users, the onset is believed to happen much earlier than in type 2 – diabetes. The skin lesions diabetes is characteristically found on the lateral and anterior areas of the lower legs i.e. in the medial malleolar and pretibial region. Additionally, they may develop on the arms, trunk and face. There may be one or several lesions, either bilateral or unilateral. The lesion develops as a tiny, dark-red prominent nodule along with a sharply circumscribed border. It slowly expands to turn into a plaque of crooked outline, flattened and depressed as the dermis turns more atrophic.
Pruritus
A prevalence of 49% has be reported in people with diabetes
Generalized Pruritus was once upon time considered a classic symptom of diabetes; however, its frequency is unknown. Studies have failed to provide a statistical ground for this belief. A higher rate of Pruritus is found in uremia, endocrine disorders (thyroid), parasitic infestation, malignant diseases, liver diseases, metabolic and hematologic diseases and as a side-effect of some drugs. Moreover, generalized Pruritus is associated with diabetes complications of chronic renal insufficiency and occasionally, neuropathy. High levels of urea in the blood underlie the skin to itch badly. Dermatophytosis or Candidiasis may cause Pruritus in diabetic patients. Anogenital Pruritus is generally triggered by candidiasis in diabetic patients.
Some common Pruritus skin infections in diabetics are athlete’s foot, jock itch and ringworm. Athlete’s foot develops on the skin between the toes and will turn sore and itchy. The affected skin may peel, blister or crack. Jock itch looks as a red, itchy area that will spread from genitals outward over the inner thighs. Jock itch is more common in males than females. Ringworm is identified by red-scaly, ring-shaped patches, which may blister or itch. Ringworm can develop on the groin, scalp, nails, trunks or feet. In elderly, itching in the legs itching is not a symptom of hyperglycemia, but instead a manifestation of xerosis.
Low potency corticosteroid and simple lubricants application can prove helpful.
Diabetic dermopathy
Diabetic dermopathy (i.e., pigmented pretibial papules and shin spots) affects 7% to 70% of all diabetic patients
It is a very common skin lesion reported in patients with diabetes. It is more prominent in males, who are more than 50 years old. It is seen even in endocrine diseases, euglycemic and in healthy people as well. The presence of small blood vessels changes has inspired the term diabetic dermopathy. The lesions are asymptomatic and haphazardly shaped patches occurring over the anterior of the lower legs; the lesions have light-brown color and their surfaces are depressed. Additionally, the lesions can appear on thighs, any bony prominences and upper arms. Lesions develop in crops and gradually subside over 12-18 months. The lesions do not require any treatment except for shielding the affected area from any secondary infection or trauma. Use of bio-occlusive dressing is strongly recommended.
Diabetic bullae
Again, this skin condition is extremely rare, but characteristic of diabetes mellitus. They mostly affect adult men. The bullae develop commonly in the dorsum and sides of lower legs, particularly feet. Sometimes, they are associated with identical lesions on the hands and forearms. Bullae may range from millimeters to a few centimeters. The lesions are generally bilateral, filled with clear sterile fluid, and there is no surrounding erythema.
Usually, bullae will go away in several weeks without any significant scarring, though they may recur. The cause of this rare manifestation in diabetic people is unknown. At least 75% of patients have considerable diabetic retinopathy, and in one series of 3-patientscutaneous and dermopathy angiopathy were present.
Dermatoses common in diabetes mellitus
Lichen planus
An increased prevalence of diabetes mellitus and anomalous insulin response to glucose challenge has been reported in patients with lichen planus. This appears common in adults, particularly those with an erosive oral form. There were several studies of lichen planus skin lesions in diabetes mellitus, which have led to an outcome that there are 2-forms of lichen planus, i.e. the metabolic defect type and immunogenic type.
Perforating dermatosis
There are many acquired cutaneous ailments having a common denominator the transepidermal elimination of degenerative material, mainly elastic fibers and collagen. Many are observed in patients with chronic renal failure, especially those on dialysis and with NIDDM or IDDM. The size of papules spans from 2 – 10 mm in diameter, usually with a keratotic plug. They commonly appear on the extensor area of the trunk and extremities, and are very itchy with slight tendency to spontaneous resolution.
Furthermore, most patients are often black, middle aged, and more often males than females. Improvements in itchy lesions are not attained easily, but ultraviolet and topical retinoic therapy has proved to be useful.
Vitiligo
It is a disorder with a reduced or absent function of melanocytes resulting in macular depigmentation. The Vitiligo skin lesions diabetes is asymptomatic, but emotionally stressful, especially in people with dark skin tone. It is mostly found in periorifacial regions and on the extensor aspect of extremities as well. The lesions occur with a greater incidence than anticipated (4.8%) in people with type-2 diabetes and with maturity onset diabetes. Moreover, it has been reported with IDDM and other autoimmune disorders of thyroid adrenal parietal cells.
Kaposi’s sarcoma
It is a compound idiopathic hemorrhagic sarcoma that develops chiefly as multiple vascular nodules in the skin and other body organs. The Kaposi sarcoma skin lesions diabetes develop on legs as numerous, purple nodules, plaques and macules. Later, other skin areas, internal organs and mucous membranes may be involved.
Edema of legs is common and may be a prodrome as well. Histologic picture depicts accumulation of spindle cells forming vascular slits comprising erythrocytes. Diabetes mellitus has been reported with higher than expected frequency in classic Kaposi’s sarcoma, but confirmation is still needed.
Eruptive xanthomas
The skin lesion commonly surfaces in hyperlipidemic status. Often the underlying issue is uncontrolled diabetes. The eruptions are multiple, appears in crops, yellowish in color, firm, waxy papules spanning from 1-4 mm in diameter. The lesions usually develop on the extensor surfaces, knees, buttocks, trunk and back. The lesions are itchy, tender and surrounded by erythematous halo.
Bullous pemphigoid
There are a few reports relating diabetes and Bullous pemphigoid; however, the relationship between the two waits for confirmation. Theoretically, their connection with one-another may be because of lower threshold of diabetes in traumatically induced blisters or due to antigenic changes at the level of lamina lucida. Immunosuppressive drugs and steroids may help.
Dermatitis herpetiformis
The HLA connection of diabetes and dermatitis herpetiformis may be a possible explanation of two-diseases appearing together more often than expected.
Luckily, most of the skin lesions diabetes discussed in this article can be treated if caught early. However, if not cared for properly, a minor skin condition in a diabetic person can turn into a serious disease with potentially severe consequences
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