SKIN DISEASES IN DIABETES MELLITUS
What Is Diabetes Mellitus?
Diabetes mellitus is a common disease affecting about 8% of the adult
population in Singapore. Diabetics have high blood sugar levels which if
not well-controlled can lead to long-term complications affecting
various organs in the body such as the eye, kidney, nervous system and
blood vessels. Skin problems are common in diabetics. Some skin diseases
are characteristically associated with diabetes mellitus.
What are some common skin diseases associated with Diabetes Mellitus?
This is the commonest skin disease seen in diabetics. Skin signs are
commonly found over the shins and appear as brown scars. The brown spots
may be preceded by red or blistering spots. The cause is due to abnormal
changes of small blood vessels in the skin. There is no specific
treatment for this skin disorder. The condition tends to heal by itself
into depressed scars.
Occlusion of large vessels in the feet due to diabetes can cause pain
on prolonged walking as a result of poor blood circulation. Severe
occlusion can lead to gangrenous changes of the toes as a result of
tissue death. Surgery will be needed to remove the dead tissues and in
severe cases, amputation of the foot or leg.
Diabetes can damage the nerves resulting from occlusion of blood
vessels to the nerves. This can cause a burning and tingling sensation
and numbness of the feet. Patients also have reduced or loss of pain
sensation and may develop skin sores and ulcers on the feet due to
trauma if good foot care is not instituted.
Diabetics are more prone to skin infections. Examples are styes,
boils and fungal infection. Some infections can be serious and require
immediate medical attention eg. carbuncles, which are deep bacterial
infections of the hair follicle (abscess) and cellulitis which
is a deep skin infection. Cellulitis often presents as a red, hot and
tender swelling of the leg. Necrotising fasciitis is a serious
and life- threatening skin infection which may extend deep down to the
muscles and requires immediate treatment and surgery. It presents as
painful, inflammed haemorrhagic swelling or blistering of the skin
This is a rare complication of diabetes, again due to small blood
vessel disease of the skin. Skin lesions usually appear on the shin. The
affected skin has a reddish brown border with a yellowish centre.
Sometimes, the onset of this skin disease may precede the diagnosis of
diabetes and so patients with this skin disorder need to be screened for
This is a skin manifestation of diabetes mellitus. It is also a skin
sign of other internal diseases including some hereditary diseases and
internal cancer. It is commonly seen in those who are obese. Skin
changes are characterised by dark, brownish black velvety thickening of
the skin folds such as the armpits, upper back, neck and
Xanthomas and Xanthelasma
Diabetics often suffer from high lipid (cholesterol and
triglycerides) levels in the blood. This causes fats to be deposited in
the skin and presents as xanthomas or xanthelasma.
symptomless yellow firm nodules usually found over bony elbows, knees
and heels. Sometimes, the appearance may be as pin-head sized yellow
lumps, appearing in crops over the buttocks (eruptive xanthomas).
Xanthelasma is a sign of high cholesterol levels in the blood and
presents as yellow patches on the eyelids. Treatment is aimed
at normalising the lipid levels by dietary restriction of satuarated
fats and if necessary, medical treatment with lipid lowering
This is a skin disease seen usually in children and young adults. It
is occasionally associated with diabetes. Skin signs are characterised
by red spots in the initial stages which expand outwards in a ring-like
fashion. The hands, especially the fingers, and elbows are commonly
affected. When granuloma annulare is widespread it may be associated
with underlying diabetes mellitus. The skin lesions may precede the
symptoms and signs of diabetes mellitus. Patients with widespread
granuloma annulare need to be screened for diabetes
WHAT SHOULD BE DONE IF YOU HAVE DIABETES
ASSOCIATED SKIN DISEASES?
When there are serious complications such as bacterial skin
infections, gangrene, seek immediate medical attention. Consult your
doctor early. You may need to be hospitalised. If left untreated, these
complications may be life-threatening. Infected ulcers need to be
treated with antibiotics.
CAN THESE SKIN COMPLICATIONS OF DIABETES
MELLITUS BE PREVENTED?
Yes. If your diabetes mellitus is well controlled, many of these skin
problems can be averted. This requires compliance with a diabetic diet,
medication and regular check-ups with your doctor. Proper skin and foot
care is important:
- Do not walk bare-footed. This is to avoid skin injuries.
- Check your feet every day for cuts and sores. Pay special
attention to the spaces in between the toes to look for inflammation
- Wear proper fitting shoes that are not too tight or loose to
prevent skin trauma.
- Cut toe nails carefully.
- If skin sores or ulcers develop, see a doctor immediately. Some
skin signs are also an indication that there may be possible
complications affecting other organs in the body such as the eye and
kidney. Your doctor will check for these complications.