Dr. Roy Moutran
Head of Department of Dermatology
Mount Lebanon Hospital (MLH)
Diabetes mellitus (DM) refers to a group of common metabolic disorders that share hyperglycemia. Several distinct types of DM exist and are caused by a complex interaction of genetics and environmental factors. Diabetes is responsible of vascular events in organs as kidney, eye, lower leg, heart... but also skin!
Skin complications occur in approximately 50% of diabetic patients. They can be divided into infectious and non-infectious. Among infectious complications, candida albicans is the mostly reported. It affects the mouth, genital area and nails. This infection should be confirmed and treated by your dermatologist. Other infections include folliculitis, abcesses... Nails of diabetic patients are particularly infected with Pseudomonas aeruginosa that makes them green (Green nail syndrome).
Non-infectious complications of diabetes include itch that can be generalized without predominant area and without any specific feature. Skin dryness is frequent and affects up to 40% of diabetic patients. Red face can be reported in 25% of diabetic cases.
Other complications are more specific of diabetes. Among these complications, diabetic dermopathy is the most frequent. It occurs in males more than females, aged above 50 years with a previous chronic diabetes history. Clinically, patients present with round, brown, well-demarcated macules over legs. Some of these macules are atrophic; however, they do not have any symptom. This condition does not require a specific treatment.
Another frequent complication is acanthosis nigricans. It consists of brown/dark macules mainly over neck and under arms. These lesions reflect a hyper-insulin state and warns about high sugar profiles. Treatment includes blanching creams; however, control of diabetes remains the major issue.
Granuloma annulare, which consist of red plaques over superior and inferior limbs have controversial association with diabetes. However, when a dermatologist confirms the diagnostic of generalized granuloma annulare, a sugar blood test should be performed.
For patients who inject insulin for diabetes control, some rare reactions have to be mentioned. Relatively rare, allergic reactions are itchy papules related to the insulin injection site. Lipoatrophy consists of atrophy of skin fat that underlie insulin injection site. Insulin pumps, widely used nowadays, can result in infections due to insufficient hygiene measures.
If you are diabetic, take care of your blood sugar... and of your skin!