Diabetes: Dr. Martin Gozar - Complete Review Including Diabetes & Skincare

Skincare complications in diabetes

Diabetes, a chronic metabolic disorder, affects approximately 463 million adults globally, with a significant impact on morbidity and mortality rates. Skin complications are prevalent in diabetes, affecting up to 80% of patients and leading to complications such as diabetic dermopathy, skin infections, and xerosis

Microvascular and macrovascular complications are common, impacting small and large blood vessels. Microvascular complications involve diabetic retinopathy, nephropathy, and neuropathy. Macrovascular complications include coronary artery disease, stroke, and peripheral vascular disease. Risk factors for complications include poor blood glucose control, high blood pressure, high cholesterol, smoking, and obesity. 

Additionally, many skin complications arise in those with diabetes. Diabetic dermopathy is characterized by light brown or red scaly patches on the skin. It is associated with microvascular complications due to prolonged high blood sugar levels. Prevention involves maintaining good blood sugar control and protecting the skin from injury.

Diabetic blisters (bullosis diabeticorum) are uncommon blisters on various body parts. They result from long-standing uncontrolled blood sugar levels and neuropathy. They are typically painless and resolve on their own; indicative of underlying complications.

Digital sclerosis affects skin and joints, causing thickening and tightening in fingers, toes, and hands. It’s associated with long-term exposure to high blood sugar levels and poor circulation. It impacts mobility and daily activities, emphasizing the need for early intervention.

Diabetic foot ulcers arise from a combination of high blood sugar, neuropathy, and poor circulation. Nerve damage leads to unnoticed injuries, poor blood flow hinders healing, and ulcers may result. It carries a high risk of infection and amputation, stressing the importance of proactive foot care.

Individuals with diabetes are prone to styes, boils, carbuncles, folliculitis, and urinary tract infections. Weakened immune systems and reduced sensation contribute to increased susceptibility.

Acanthosis nigricans are dark, thickened patches of skin linked to insulin resistance and obesity. They’re not harmful but serve as a visible indicator of underlying health issues. Management involves lifestyle modifications, addressing insulin sensitivity, and treating underlying conditions.

Organizations like the American Diabetes Association emphasize regular skin assessments, patient education, and prompt intervention. Education includes proper cleansing, moisturizing, and skin inspection, with recommendations for suitable emollients and moisturizers. Healthcare professionals are advised to prescribe antimicrobial therapies, dressings, or topical treatments as needed.

Emollients play a crucial role in hydrating the skin, preventing dryness, and relieving symptoms like itching. Topical treatments, including antibiotics, antifungals, and steroids, are valuable in managing bacterial and fungal infections, as well as inflammation. Selection should be based on the specific skin complication, with close monitoring to ensure safe and effective use.Proper skin pH maintenance is highlighted, as high pH products may exacerbate conditions like candidal intertrigo. Regular cleansing and moisturizing, particularly with ceramides-containing products, can sustain physiological skin pH, enhance barrier function, and potentially reduce complications. Recognizing and managing diabetes-related skin conditions is vital for improving patients' quality of life and preventing serious adverse effects. Consistent skin care, including moisturizer application, emerges as a valuable measure to address skin barrier dysfunction in diabetes.

References:

David P, Singh S, Ankar R. A Comprehensive Overview of Skin Complications in Diabetes and Their Prevention. Cureus. 2023 May 13;15(5)

Epidemiology of diabetes and diabetes-related complications. Deshpande AD, Harris-Hayes M, Schootman M. Phys Ther. 2008;88:1254–1264

Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the International Diabetes Federation Diabetes Atlas, 9(th) edition. Saeedi P, Petersohn I, Salpea P, et al. Diabetes Res Clin Pract. 2019;

Kirsner RS, Yosipovitch G, Hu S, Andriessen A, Hanft JR, Kim PJ, Lavery L, Meneghini L, Ruotsi LC. Diabetic Skin Changes Can Benefit from Moisturizer and Cleanser Use: A Review. J Drugs Dermatol. 2019 Dec