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S. William Levy, MD, is a dermatologist with more than 50 years of experience treating diabetes-related skin conditions.
We caught up with Dr. Levy recently and invited him to answer questions frequently asked by people with diabetes about their skin.
Why do people with diabetes tend to have a higher incidence of skin complications?
Nobody really knows, but many believe it is due to a narrowing of the smaller blood vessels near the skin (microangiopathy). In nondiabetics, these smaller blood vessels protect the skin. But in people with diabetes, these vessels become constricted and eventually may even become completely clogged.
Because of the restricted blood supply, wounds don’t heal very quickly, which can lead to infection. When this happens the tissues dry up and gangrene can set in, which may eventually lead to amputation. Remember, even simple bites and scratches can lead to ulcerations (sores on the surface of the skin).
Why are the feet a focal point when it comes to diabetes-related skin problems?
Because of the occluded blood vessels. The circulation is poorest around the toes and on the feet, causing bacterial and fungal infection. People with diabetes also tend to have less feeling in their feet and toes. Due to the loss of protective sensation, they may be unaware of a cut or blister and will ignore it until, often, it becomes much worse.
The diabetic foot is the result of systemic changes associated with increased blood glucose, which can cause the classic triad of neurological, vascular and immune system deficits that can ultimately result in amputation.
What kind of precautions can people with diabetes take to reduce their risk of skin problems?
Maintain good hygiene and check the skin, and especially the feet, every day.
First of all, use antibacterial soap, also called deodorant soaps. These include Lever 200, Dial and Safeguard, all of which contain antiseptics to lower the skin’s bacterial fungal count. Bacterial infections need to be treated early and aggressively to prevent progression. In addition to these soaps, appropriate topical or oral antibiotics can be used when indicated by a physician.
How can fungal infections be avoided?
Zeasorb powder and Sarna lotion are antifungal over-the-counter treatments used for this purpose. Female patients can use them under their breasts to prevent fungal infections there. Both of these products will help dry the skin in the groin area as well.
Also, avoid having the cuticles pushed back when getting a manicure, as this can cause possible yeast or fungal infections.
Poor immunity to bacteria and fungi does not improve even if the blood glucose is controlled. There is an unknown relationship to susceptibility for people with type 1 diabetes—even when they have good control. Type 2 susceptibility, however, does hinge on control. Over-the-counter antifungal creams are available if athlete’s foot is active.
What kinds of lotions do you recommend to treat skin problems?
Creams are okay as long as they don’t irritate the skin, but every individual is different. If a person gets cracks on the skin of the feet, creams can seal them up. Two suggested products are Am-Lactin and Eucerin, which are all sold over the counter.
Another way to seal up cracks and to prevent or treat bacterial infections is to use antibacterial ointments. During the winter months, when there is cracking between the toes or on the feet, it is very important to immediately start using a lotion to help close them up. Seek help from a podiatrist or dermatologist if the cracks are not healed within a few weeks.
What kinds of socks should people with diabetes wear to help control foot problems?
Stay away from pure nylon, dacron and wool socks. They can irritate some skin and cause excessive sweating, which causes cracks and fissures. People with diabetes should stick to cotton or cotton blends, and change them frequently when moist.
What else do people with diabetes need to know about skin care?
People with diabetes should protect themselves from the sun and should teach their children to do the same. They should teach their children at a young age to always wear a hat in the sun and to wear sunscreen every day (even on cloudy days) to prevent skin cancer in later years. Sunscreens are available with sun protective factors (SPF) ranging from 8 to 50. An SPF of at least 15 or 30 is recommended for daily use.
S. William Levy, MD, is a clinical professor of dermatology at the University of California San Francisco Medical Center. A solo practitioner who writes for medical journals about skin complications of amputees related to diabetes, he is also author of the book “Skin Problems of Amputees.” He has no financial interest in any of the products mentioned in this article.
Jan 1, 2005
Diabetes Health is the essential resource for people living with diabetes- both newly diagnosed and experienced as well as the professionals who care for them. We provide balanced expert news and information on living healthfully with diabetes. Each issue includes cutting-edge editorial coverage of new products, research, treatment options, and meaningful lifestyle issues.