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Diabetes and
the Skin
From Head to Toe
SCOTT MURRAY MD FRCP
Established or probable
association
Necrobiosis lipoidica diabeticorum (NLD)
Diabetic dermopathy
Diabetic bullae
Acanthosis nigricans
Scleredema diabeticorum
Limited joint mobility and waxy skin syndrome
Partial lipodystrophy
Eruptive xanthomas
Carotenemia
Pruritus
Possible association
Disseminated granuloma annulare
Vitiligo
Increased susceptibility to infections:
Candida albicans
Staphylococcus aureus
Pseudomonas aeruginosa
Damaged circulation
Leg ulcers
Cold feet
Necrosis
Damaged nerves
Trauma
Neuropathic leg ulcers
Necrobiosis Lipoidica Diabeticorum Also caused by changes in blood vessels
Similar to Diabetic Dermopathy but the spots are
fewer in number and larger and deeper
Can be itchy, painful, and difficult to treat1
Diabetic Dermopathy
Caused by changes in the small blood vessels
Light brown, scaly, atrophic patches
Usually occur on the shins
Lesions do not itch, hurt, or
open up
Diabetic Blisters (Bullosis
Diabeticorum)
Most commonly on the backs of fingers, hands,
toes, feet, and sometimes on legs or forearms
Look like burn blisters
Acanthosis Nigricans
Hyperpigmented, velvety, hypertrophic plaques
Most commonly found in armpits, neck, and
groin2
Acanthosis nigricans
scleredema
Digital Sclerosis Tight, thick, waxy skin most commonly on the back of the hand
Finger joints can become stiff
Lipodystrophy- loss of fat
Eruptive Xanthomatosis
Firm, yellow, pea-like enlargements in the skin
Most often on backs of hands, feet, arms, legs,
and buttocks
Common Skin Problems Cont.
ITCHY!!!!!!!!!!! Often a result of yeast
infection, dry skin, and/
or poor circulation
Granuloma Annulare
Disseminated
Vitilgo
Common Diabetic Skin
Problems
Bacterial infections Cellulitis
Folliculitis
Common Diabetic Skin Problems
cont.
Fungal Infections Tinea pedis (athlete’s foot)
Tinea cruris (jock itch)
Vaginal yeast infections
Onychomycosis (fungal infection of the nails)
PERLECHE
Foot problems
The feet can be affected by: Decreased blood supply
poor healing
Nerve damage
loss of feeling
High Blood Sugar levels
decreased healing
increased infections
Peripheral Vascular Disease
Diabetics are more prone to
develop atherosclerosis, which
can result in peripheral
vascular disease
Claudication
Delayed healing
Cold, pale, hairless legs
and feet
Thick nails
Ulcers
Gangrene
Diabetic Foot Ulcers
Diabetic Neuropathy
Infections
infections In diabetics-worse than they
appear!!!!
Assessment and awareness Regular assessment of feet is important to check for:
Sense of feeling and pulses in the feet
Foot problems/deformities or past history of foot ulcer
If foot problems are present feet referral to a podiatrist is recommended.
Beware of Loss of feeling
Poor blood supply
Past history of foot ulcer
Identification of a problem
Daily inspection of the feet note: Broken skin
Redness
Swelling
Corns/callus
Black/blue areas
Report to nurse/GP or podiatrist
for assessment if you detect any
of these problems
Diabetic Foot Exam
Check feet daily for sores, ulcers, cuts
Wear broad, flat shoes that fit properly
Check shoes for foreign objects before putting
them on
Skin Care
Examine feet for sores, cuts, blisters, etc.
Moisturize skin and use gentle soaps when
showering
Treat cuts/breaks in skin
Treat fungal infections of the feet
Keep skin dry and clean
Prevention and Treatment of Skin
Conditions
Good News:
The majority of the
skin conditions
discussed can be
prevented or treated
by good blood glucose
control!!!
Prevention is better
than cure!
Prevention and early
identification of foot
problems can
prevent foot ulcers
and amputation