Diabetic Skin Issues and Tips on How to Help Manage Them

Up to 70% of people living with diabetes will experience diabetes skin issues at some point in their lives.1 Understanding common diabetic skin issues, treating diabetic skin conditions and how to recognize them, as well as finding ways to help prevent or manage them, is an important part of living well with diabetes.

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Acanthosis Nigricans (Skin Darkening)

Acanthosis nigricans is a common discoloration associated with diabetes. Appearing as dark, velvety, thick skin, as well as skin tags, usually in areas such as the back of the neck, elbows, hands, or groin.1

Since acanthosis nigricans is associated with obesity, weight loss may help improve issues, and topical treatments can help manage it.3

Xerosis (Dry Skin)4

Xerosis, characterized by rough, dry skin condition, is a skin manifestation in diabetes, often linked to poor skin protection and small blood vessel damage (microangiopathy).

Applying moisturizer can help improve skin hydration and reduce symptoms like scaling, cracking, and itching. Unmanaged, xerosis can lead to callus formation, increasing the risk of diabetic foot ulcers.

What Causes Digital Sclerosis (Tight, Waxy Skin)5

Digital sclerosis results in thick, tight, waxy skin around the joints of the fingers, toes, and hands in people with diabetes.

The cause of digital sclerosis is not known, but it is believed to be associated with high blood sugar levels and poor circulation. The affected areas are prone to cracking, which increases the risk of bacterial infection.

Can Diabetic Dermopathy Go Away? (Shin Spots)1

Diabetic dermopathy, or "shin spots," is the most common diabetes and skin issues in people living with diabetes; it appears as light brown or red scaly patches on the skin, particularly the shin.

Even though diabetic dermopathy is harmless, and can go away on its own, people living with diabetes should still strive to prevent it from occurring by maintaining blood sugar control and practicing good skin hygiene

Foot Calluses and Diabetes9

Foot calluses are a common complication for people with diabetes. They occur when nerve damage causes abnormal pressure on the feet. As a result, the skin produces extra keratin, forming a callus that can lead to foot ulcers.

The connection between high blood sugar, insulin levels, and callus formation is not fully understood. More research is needed to determine if individual genetic factors influence the risk of developing a foot ulcer.

Scleredema Diabeticorum (Thick, Hard Skin)

Scleredema leads to thickened, hardened skin, often affecting the back, shoulders, and back of the neck. It can also involve the face, chest, stomach, or thighs.1 Your healthcare provider may perform a biopsy to support diagnosis.

Scleredema does not usually go away and may worsen over time, potentially leading to other diabetes related skin problems.4 Prevention is key, supported by good blood sugar control.1

Candidiasis Diabetes Fungal Infections

Candidiasis is a common bacterial and fungal infection in the general population but may appear more frequently in people living with diabetes.6 It can appear in the mouth, the folds of the skin, and genital areas, as a creamy or red rash.6 Candidiasis can be treated with topical or oral antifungal medications.6 Candidiasis can also appear as a rash on the lower back or a rash on the lower legs above ankles.

Onychomycosis affects the toenails and can increase the risk of more serious foot issues like neuropathy. Your healthcare provider should perform an annual examination of your feet to assess for these issues specifically.8 With onychomycosis, nails appear thick, brittle, and discolored.7 Treatment options include topical and oral therapy; due to the slow-growing nature of toenails, it may take time to see improvement.7 Checking for rash on feet, including your nails, for any visible signs of skin infection is key.7

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References:

  1. Labib A, Rosen J, Yosipovitch G. Skin manifestations of diabetes mellitus. April 2022. In: Feingold KR, Anawalt B, Blackman MR, et al, editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. PMID: 29465926.
  2. Diabetes Care Community. Diabetes and Skin Complications. DiabetesCareCommunity.ca. Published March 17, 2021. Accessed December 11, 2024. Available
    from https://www.diabetescarecommunity.ca/living-well-with-diabetes-articles/diabetes-management-articles/diabetes-and-skin-complications.
  3. Duff M, Demidova O, Blackburn S, Shubrook J. Cutaneous manifestations of diabetes mellitus. Clin Diabetes. 2015;33(1):40-8. doi: 10.2337/diaclin.33.1.40.
  4. Piérard GE, Seité S, Hermanns-Lê T, Delvenne P, Scheen A, Piérard-Franchimont C. The skin landscape in diabetes mellitus. Focus on dermocosmetic management. Clin Cosmet Investig Dermatol. 201315;6:127-35. doi: 10.2147/CCID.S43141.
  5. David P, Singh S, Ankar R. A comprehensive overview of skin complications in diabetes and their prevention. Cureus. 2023;15(5):e38961. doi: 10.7759/cureus.38961.
  6. Rodrigues CF, Rodrigues ME, Henriques M. Candida infections in patients with diabetes mellitus. J Clin Med. 2019;8(1):76. doi: 10.3390/jcm8010076.
  7. Winston JA, Miller JL. Treatment of onychomycosis in diabetic patients. Clin Diabetes. 2006;24(4):160-166.
  8. Embil JM, Albalawi Z, Bowering K, Trepman E: Diabetes Canada Clinical Practice Guidelines Expert Committee. Foot Care. Can J Diabetes. 2018;42 Suppl 1:S222-S227. doi: 10.1016/j.jcjd.2017.10.020.
  9. Arosi I, Hiner G, Rajbhandari S. Pathogenesis and Treatment of Callus in the Diabetic Foot. Curr Diabetes Rev. 2016;12(3):179-83. doi: 10.2174/1573399811666150609160219. PMID: 26054651.