For Healthcare Professionals

Skin Problems and Skin Care

Ways to keep skin healthy

Healthy skin isn't just about how you look, and people with diabetes shouldn’t take it for granted. When there's too much glucose in your bloodstream, your body will try to flush it away, losing moisture in the process. As a result, people with diabetes tend to have dry skin. Much of a diabetes skin care regimen, then, revolves around replenishing that moisture.

High blood glucose levels can affect your skin in several ways:

• loss of fluids (dehydration) due to more frequent urination can make your skin dry
  
• skin may become extra dry, itchy or cracked
  
• you may develop rashes, boils, pimples or other skin changes
  
• blood vessels may become damaged and impede blood flow, preventing an injured area from getting enough oxygen and nutrients to heal properly
  
• nerves may become damaged and make some parts of your body, like legs and feet, sweat less, which can also result in dry, cracked heels
  
• the number of germ-fighting white blood cells in your body may be reduced, also making you more prone to infections that can spread faster, be harder to treat and take
• longer to heal

Additionally, people with diabetes often experience thickening of the skin, resulting in a yellow, waxy appearance, a condition that may be linked with a decrease in joint mobility. Blood glucose control may help this thickening, but there is no known treatment or cure.

Another skin condition found in people with diabetes, particularly in older men, is diabetic dermopathy, in which small, round, coloured spots appear on the lower legs. While this condition may look unappealing, it does not indicate a health threat and doesn't need to be treated.

Yellowish skin, fingernails and toenails are common among people with diabetes. While yellow-tinted skin may be the result of eating a lot of yellow or orange vegetables containing carotene, the cause of yellowing fingernails and toenails may be due to fungal infection. These fungal infections should be treated.

Common infections related to diabetes

Excessively itchy skin is a problem that can be treated most often by moisturizing or steroid cream. Most infections can also be treated with medication. Infections that are common with diabetes include:

• yeast infections that appear on moist areas of the body like the mouth or underarms, under the breasts or on the sides of the groin
  
• bacterial infections like impetigo, abscesses and cellulitis
  
• fungal infections that appear around the groin, between the toes, on the palms of hands or under fingernails and/or toenails

Avoiding infection

Follow these tips to help avoid infection and keep your skin looking healthy:

Cleaning

• Use a mild soap that won't rob your skin of natural oils or cause irritation. Some deodorant soaps or those with heavy fragrances can be harsh to your skin.
  
• Use warm, not hot, water and limit your use of soaps or cleansers to the parts of your body that sweat. Always rinse off soaps or cleansers completely.
  
• Spend only 5 to 10 minutes in the tub or shower. Staying in too long can cause your skin to dry out.
  
• Pat skin dry with a soft towel. Avoid rubbing, but be thorough, especially under skin folds like those under the arms and breasts, and groin area. High blood glucose combined with moisture, warmth and darkness in these areas can lead to yeast and bacterial infections.

Moisturizing

• Drink plenty of water or sugar-free fluids.
• Apply moisturizing lotion to your skin after bathing while skin is damp. Do not use lotion in skin folds like areas between toes and under breasts where infections can develop.
• Avoid lotions and creams that contain dyes, additives, fragrance or perfumes.

Sun and wind

• Always wear a sunscreen with a sun protection factor (SPF) of 30 when going outdoors.
  
• Avoid para-aminobenzoic acid (PABA) in sunscreen as it may irritate your skin. Read labels for details.
  
• Limit time in the sun to avoid sunburn and skin dryness. Remember, a sunburn can affect your blood glucose and disrupt your control.
  
• Wear appropriate layered clothing to protect from the sun, cold weather, and wind.

Injury

• Wash minor breaks in skin with antibacterial soap and water.
  
• Don't use iodine or products containing alcohol or peroxide, as these can be too strong for the skin.
  
• Cover with a non-stick sterile pad or sterile gauze and tape.
  
• Don't place gauze, adhesive tape or sterile pads directly on the broken skin. Skin can be further damaged when these are removed.
  
• Don't force a blister open, it has a natural sterile protective cover. When it breaks open naturally, care for it as you would any other break in the skin.
  
• Check the injured area everyday to be sure you are healing.

Feet

• Have your healthcare professional check your feet at very visit.
  
• Be sure the shoes you wear completely cover your feet. Open-toe or open-heel shoes can cause skin to dry out and crack.
  
• Don't use commercial corn or callus products as they can cause a chemical burn.
  
• Don't use a pumice stone on your feet. It can cause problems, especially if you have impaired feeling in your feet.

When to call your doctor

The following symptoms can be serious. Seek medical attention if you have:

• very dry, itchy, cracked skin
  
• skin that is red, swollen or feels warm or hot
  
• skin that has pus or bad-smelling drainage
  
• a cut or scratch that does not heal