Diabetic Skin Rash: Types, Causes, Treatment and More - EndocrineWeb

Diabetes can impact the health of your entire body, including the skin. As the largest organ in the body, your skin has many functions, like protecting you from infection, UV rays, and injury.

There are a few different skin conditions linked with diabetes. Some changes in the skin may happen before diabetes is even diagnosed. Fortunately, if recognized early, most skin problems can be effectively treated.

Causes of Diabetes-Related Skin Problems

Skin conditions are seen in almost 30% of people with diabetes. Hyperglycemia, or high blood glucose levels, can happen with uncontrolled diabetes. This condition is linked with many complications, both microvascular and macrovascular.

Microvascular complications are related to the very small blood vessels in the body. Changes in the small blood vessels can impact the eyes and kidneys.

Macrovascular complications refer to damage in the larger blood vessels, like the arteries that move blood away from the heart.

Together, microvascular and macrovascular changes may be linked to nerve tissue damage because they can stiffen and narrow the arteries.

According to the Centers for Disease Control and Prevention (CDC), about half of all people with diabetes will develop some form of neuropathy, or nerve damage. Neuropathy can impact sensation and healing in the skin.

Diabetes may also negatively affect circulation. This means it can lower the amount of nutrients and oxygen which the extremities (like the hands and feet) and skin receive. This makes it harder for skin to heal.

"Diabetic foot wounds are probably the most common things that are problematic, which can be related to poor blood flow and diabetic nerve disease," explained Richard Siegel, MD, endocrinologist and co-director of the Diabetes and Lipid Center at Tufts Medical Center in Boston.

Poor circulation may also cause itchiness in the skin. Hyperglycemia may lead to dry skin because of a fluid imbalance. This happens when the body's water is used to flush out the extra glucose, instead of being used to keep the skin hydrated.

Skin Symptoms to Watch For

Changes in your skin may signal changes on the inside of your body. It's important to let your health care provider know if you notice anything unusual.

If you have diabetes, watch for the following skin symptoms:

Bacterial and Fungal Infections

High glucose levels can put you at risk for developing infections. Although bacteria and fungi are usually recognized and stopped by the immune system, "when blood sugars are out of control (above 180 mg/dL to 200 mg/dL), the immune system doesn't work as well," Dr. Siegel explained.

When the immune system doesn't work properly, small issues can grow into larger ones. "What could be a simple folliculitis inflammation of the skin could then turn into more of a bacterial abscess," or a swollen lump of pus, said Dr. Siegel.

Your body may also have a harder time healing from an infection, Dr. Siegel stated: "Hyperglycemia definitely can worsen a pre-existing infection in terms of its ability to heal up."

Generally, you can tell if you have an infection because the affected area will be hot, painful, and swollen. The following are infections that people with diabetes may experience:

• Boils: A boil is a pus-filled bump on the skin similar to a large, painful pimple. A group of boils that are close together is called a carbuncle.

• Styes: These often-painful infections in the eyelash follicles happen because of blockages in the oil glands of the eyelid.

• Nail infections: A fungal infection in the toenails, such as onychomycosis, may cause your toenails to be discolored, thickened, or cracked.

• Athlete's foot: Not limited to athletes, this fungal infection may cause cracks, itchiness, and flaky skin between the toes and on bottom of the feet. "People with diabetes definitely are more prone towards foot fungus," Dr. Siegel noted.

• Jock itch and vaginal infection:Yeast infections are due to an overgrowth of naturally occurring yeast. These infections can cause itchiness, redness, rashes, and small blisters.

• Ringworm: Named ringworm only because of its circular shape (it doesn't involve a worm), this fungal infection of the skin may be itchy and red, with a raised border.

Diabetic Dermopathy

Occurring more frequently in people over 50, diabetic dermopathy (DD) is a common skin condition in diabetes. In those with DD, scaly brown patches may develop on the front of the legs.

The patches aren't usually painful. Sometimes mistaken for age spots, they're harmless and don't need to be treated.

Necrobiosis Lipoidica Diabeticorum

Like DD, necrobiosis lipoidica diabeticorum (NLD) affects the skin on the legs. However, with NLD the spots are typically larger, deeper, and red. The affected area may be painful and itchy.

While NLD may happen more often in women, Dr. Siegel noted that it's "actually fairly rare." No treatment is necessary unless the spots crack and open. Dr. Siegel added that NLD usually doesn't cause problems "unless there are significant ulcers," adding that "wraps of topical treatment with steroids can sometimes be of value."

Digital Sclerosis

Digital sclerosis may cause the skin on the back of the hands to become waxy, thick, and tight in appearance. As a result, there may be stiffness in the joints, making it harder to bend your fingers.

Digital sclerosis may spread to the skin in other parts of the body if blood glucose levels stay high. It's more likely to occur in people with type 1 diabetes. Treatment involves management of glucose levels, and physical therapy to gain mobility of the joints.

Disseminated Granuloma Annulare

Disseminated granuloma annulare causes ring-shaped red or brown areas on the skin. There are several types of granuloma annulare, including localized (in one area) or disseminated (general, more widespread). It may show up on the ears, hands, and torso.

Granuloma annulare is associated with both diabetes and hyperlipidemia, or high levels of fat in the blood. There are medications that are used to treat the condition.

Acanthosis Nigricans

Acanthosis nigricans (AN) is a darkening of the parts of the skin that are velvety in texture. These include the folds of the skin around the neck, groin, and armpits. AN also causes thickening of the skin. It's most related to diabetes and insulin resistance.

There is no treatment for AN. However, it may fade with improved glucose levels. In some cases, creams may help lighten the affected areas.

Diabetic Blisters

Bullosis diabeticorum, or diabetic blisters, may make it look like you've been burned, but they're typically painless. Diabetic blisters may show up on your hands, feet, legs, or arms. The blisters will normally heal on their own, without leaving behind scars. Managing blood glucose will help treat the blisters and help prevent them.

Treatment Options for Diabetic Skin Rashes

While some of the diabetes-related skin conditions go away on their own, there are others that require treatment. Treatments may include:

• Over-the-Counter Treatments (OTC): There are multiple OTC options available to treat diabetic skin rashes. The type of skin condition you have will determine the treatment. For example, you can use OTC antifungal cream to treat athlete's foot. Always check with your health care provider before using an OTC medication.

• Medications: In some cases, you'll need more than an OTC treatment. Your health care provider may choose to prescribe antibiotics, prescription antifungals, or other medication to treat your specific skin condition. And "from a cosmetic standpoint, a dermatologist may have something to offer," said Dr. Siegel.

• Lifestyle changes: Treating any diabetes-related skin condition will include managing blood glucose levels. The best management of diabetes includes addressing lifestyle factors and making behavior changes. Diabetes self-management includes:

  • Healthy coping: The hormones produced when you're stressed may cause your blood glucose to go up. Lowering stress can help improve your diabetes. Examples of healthy coping might be talking with a friend, being active, doing something you enjoy, and getting enough sleep.

  • Healthy eating: The foods you eat impact your blood glucose levels. To make sure you are eating in a way that helps manage your diabetes, try meal planning and learning to read food labels. Dietary patterns that focus on high vegetable and fruit intake, whole grains, healthy fats, and lean proteins may improve blood glucose levels.

  • Being active: You can improve your blood glucose levels by including more movement in your day. The American Diabetes Association recommends that people with diabetes get 150 minutes of moderate to vigorous activity every week. This may include walking, gardening, yoga, swimming, and weightlifting.

  • Taking medications: To best manage your diabetes, it's important to take diabetes medications as prescribed.

  • Monitoring: How often you check your blood glucose levels at home depends on your treatment goals.Monitoring your own levels gives you immediate feedback and can show you how your diet and physical activity are impacting your levels.

  • Reducing risks: To reduce risk of diabetes complications, you should regularly follow up with your health care provider. They'll check things like your blood pressure, sensation in your feet, and your cholesterol levels. In addition, participating in diabetes education, getting enough sleep, and stopping smoking can all reduce your risk for diabetes-related complications.

  • Problem solving: Managing your diabetes may require adjustments to your treatment over time. Recognizing when you need to make changes in your lifestyle habits can help you reach your blood glucose goals.

What is the Outlook if You Have a Diabetes-Related Skin Issue?

Diabetes-related skin conditions can be frustrating or uncomfortable. But most are easily treated with management of blood glucose levels.

If you have diabetes, let your health care provider know as soon as you recognize any changes in your skin. Remember that what may be occurring on the skin's surface might reflect what is happening in the body.

When treated early, most diabetes skin conditions have no lasting impact on overall health.

• Sanches MM, Roda Â, Pimenta R, et al. Cutaneous Manifestations of Diabetes Mellitus and Prediabetes. Acta Med Port. 2019 Jun 28;32(6):459-465. doi:10.20344/amp.10738. PMID: 31292028.
• Labib A, Rosen J, Yosipovitch G. Skin Manifestations of Diabetes Mellitus. [Updated 2022 Apr 21]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK481900/
• Diabetes and Your Skin: https://www.cdc.gov/diabetes/library/features/diabetes-and-your-skin.html
• Barbieri JS, Rosenbach M, Rodriguez O, et al. Association of Granuloma Annulare With Type 2 Diabetes, Hyperlipidemia, Autoimmune Disorders, and Hematologic Malignant Neoplasms. JAMA Dermatol. 2021 Jul 1;157(7):817-823. doi:10.1001/jamadermatol.2021.1805. PMID: 34106218; PMCID: PMC8190702.
• Brady MF, Rawla P. Acanthosis Nigricans. [Updated 2022 Oct 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431057/
• Association of Diabetes Care and Education Specialists, Kolb L. An Effective Model of Diabetes Care and Education: The ADCES7 Self-Care Behaviors™. Sci Diabetes Self Manag Care. 2021 Feb;47(1):30-53. doi: 10.1177/0145721720978154. PMID: 34078208.
• Martín-Peláez S, Fito M, Castaner O. Mediterranean Diet Effects on Type 2 Diabetes Prevention, Disease Progression, and Related Mechanisms. A Review. Nutrients. 2020 Jul 27;12(8):2236. doi: 10.3390/nu12082236. PMID: 32726990; PMCID: PMC7468821.
• American Diabetes Association Professional Practice Committee, Draznin B, Aroda VR, Bakris G, Benson G, Brown FM, Freeman R, Green J, Huang E, Isaacs D, Kahan S, Leon J, Lyons SK, Peters AL, Prahalad P, Reusch JEB, Young-Hyman D. 5. Facilitating Behavior Change and Well-being to Improve Health Outcomes: Standards of Medical Care in Diabetes-2022. Diabetes Care. 2022 Jan 1;45(Suppl 1):S60-S82. doi: 10.2337/dc22-S005. PMID: 34964866.
• American Diabetes Association Professional Practice Committee, Draznin B, Aroda VR, Bakris G, Benson G, Brown FM, Freeman R, Green J, Huang E, Isaacs D, Kahan S, Leon J, Lyons SK, Peters AL, Prahalad P, Reusch JEB, Young-Hyman D. 7. Diabetes Technology: Standards of Medical Care in Diabetes-2022.* Diabetes Care*. 2022 Jan 1;45(Suppl 1):S97-S112. doi: 10.2337/dc22-S007. PMID: 34964871.

Notes: This article was originally published December 7, 2022 and most recently updated December 16, 2022.

Medical Writer

Erin Davis, MS, RDN, CDCES, is a freelance medical writer and consultant who has over 15 years of clinical and community experience as a dietitian and diabetes educator.

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