The following skin conditions occur almost exclusively in people who have diabetes.
This common skin condition is characterized by depressed, irregularly round or oval, light brown, shallow lesions.
Lesions may vary in number from few to many and are usually found on both legs but are not symmetrically distributed.
Dermopathy appears as scaly patches that are light brown or red, often on the front of the legs. The patches do not hurt, blister, or itch, and treatment generally is not necessary. The patches are sometimes called skin spots.
Because these lesions do not itch, hurt, or open up, they are often overlooked and not reported to the health-care provider.
5B.Diabetic blisters (bullosis diabeticorum)
This is an uncommon condition in which blisters occur on the hands and feet and sometimes also the legs and forearms.
The blisters are unrelated to trauma or infection; they develop spontaneously and may become quite large.
In rare cases, people with diabetes develop blisters that resemble burn blisters. These blisters—called bullosis diabeticorum—can occur on the fingers, hands, toes, feet, legs, or forearms.
Diabetic blisters usually are painless and heal on their own. They often occur in people who have diabetic neuropathy.
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Foot ulcers are a serious problem that can ultimately lead to amputation if left untreated.
Each year, about 2% to 3% of people with diabetes develop a foot ulcer.
Approximately 15% of people with diabetes develop a foot ulcer at some point in their lifetime.
Foot ulcers are erosions on the skin of the feet.
Some affect just the outermost layers of skin, while others extend to deeper tissues.
Ulcers often begin as a result of minor trauma, such as irritation from ill-fitting shoes that goes unnoticed or untreated.
The most common locations for ulcers to develop are the weight-bearing areas of the foot such as the heel and the ball of the foot and sites subject to pressure such as the toes or ankles.
A number of factors make people with diabetes more likely to develop foot ulcers than those without diabetes.
Neuropathy is one risk factor. Almost all people with diabetes who develop typical foot ulcers have neuropathy that affects their motor, sensory, or autonomic nerves.
Neuropathy in the motor nerves causes weakness, thinning, and limitation in the movement of certain muscles in the foot, leading to deformities in the normal foot shape such as atypically high arches, claw toes (all toes except the big toe bend toward the floor) and hammer toes (the longest toe bends toward the floor at the middle toe joint).
Neuropathy of the sensory nerves results in loss of protective sensation to pain, pressure, and heat.
People with sensory neuropathy may therefore not be aware of cuts, abrasions, and calluses that can lead to ulcers.
Depending on the amount of sensory neuropathy, people may even be unaware of major traumas to their feet, such as occur from stepping on pins, glass, and other sharp objects.
Neuropathy of the autonomic nerves can lead to warm, excessively dry feet that are prone to skin damage.
Peripheral vascular disease is another factor that can contribute to the formation of foot ulcers in people with diabetes.
Because of the decreased blood circulation to the feet in this condition, there is an impaired delivery of oxygen, nutrients, and antibiotics.
Therefore, wounds tend not to heal well and to become infected.
Foot ulcers warrant immediate attention and treatment.
The doctor will need to determine how deep and infected the ulcer is.
He may take an x-ray of the foot to check whether infection has spread to the bone.
Treatment for a foot ulcer may include oral or intravenous antibiotics to control the infection, as well as dressings and salves with lubricating, protective, antibiotic, or cleansing properties.
Taking care of the ulcer and following up with health-care providers is very important for preventing complications that could eventually lead to an amputation.
Proper foot care is a vital part of preventing minor wounds from developing into ulcers. This means the feet should be inspected daily for cuts, sores, or other forms of irritation.
The toenails should be cut straight across. (If a person cannot see or reach his feet, a health-care provider should cut his toenails.)
The feet should be washed daily in warm water and carefully dried, especially between the toes. A moisturizing lotion should then be applied, but not between the toes.
A health-care provider should examine the feet at least once a year.
People with risk factors for developing a foot ulcer, such as neuropathy, foot deformities, calluses, or a history of foot ulcers, should have their feet inspected by a doctor more often, preferably every one to six months.
If a person notices a blister, cut, scratch, sore or other form of irritation, he should be sure to notify his health-care provider immediately.
People with diabetes should avoid walking barefoot, even when indoors.
Socks or stockings should also be worn to reduce friction between the foot and the shoe.
If possible, choose seamless socks and stockings.
Wearing shoes that fit is very important, since ill-fitting footwear is a major cause of foot ulcers.
Shoes should have some room, preferably 1/2—5/8 inch, between the front of the shoe and the longest toe.
The width of the shoe should accommodate the ball of the foot, and the toes should not be cramped.
Selecting a store with a certified pedorthist on staff is a good idea, since this person will know the subtle differences between various styles.
It is best to select shoes toward the end of the day, when feet are at their largest.
People who have lost the protective sensation in their feet due to neuropathy or those who have peripheral vascular disease, foot deformities, calluses, ulcers, or other special circumstances should discuss getting customized shoes with their doctor.
5D.Necrobiosis Lipoidica Diabeticorum (NLD)
If you’ve had diabetes for a long time without good control of your blood sugar, you could get NLD. Poor blood supply to the skin can cause changes in the collagen and fat underneath.
The overlaying skin becomes thin and red. Most lesions are found on the lower parts of the legs and can turn into an ulcer if there’s trauma.
Lesions have fairly well-defined borders. Sometimes, NLD is itchy and painful. As long as the sores don’t break open, you won’t need treatment for them. If the sores do break open, see your doctor.
Due to poor blood flow, the skin on your toes, fingers, and hands becomes thick, waxy, and tight. It can also make your finger joints stiff.
Get your blood sugar under control, because that can help treat this condition.
Try lotions and moisturizers to help soften the skin.
Blood fats called triglycerides form yellow, waxy bumps ringed by a red halo.
They most frequently develop on your arms, legs, buttocks, feet, and the backs of your hands, and disappear when your diabetes is under control.
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