Diabetes and skin conditions

If you have diabetes, almost every part of your body can be affected in one way or another. And your skin is no exception. Indeed according to the American Diabetes Association, skin problems are sometimes the first sign that you have diabetes (i).
 
While it’s not something that’s talked about as much as some other diabetes complications such as heart, kidney and nerve conditions, skin problems are quite common. Some sources suggest that around one in three people with diabetes will develop a rash or another type of skin problem at some point (ii).
 

What skin problems does diabetes cause?

A paper published in the journal Clinical Diabetes, however, suggests the figure may be even higher (iii). After studying 750 people with diabetes, the study found almost 80 per cent of people with diabetes are affected by skin disorders, the most common being:
 

• Skin infections (47 per cent)

• Dry skin, also called xerosis (26 per cent) 

• Inflammatory skin conditions such as itchy, red rashes (21 per cent) 

 
The same study also claims people with type 2 diabetes are more likely than those with type 1 diabetes to develop skin problems.
 

Can high blood sugar cause skin problems?

The chief culprit when it comes to skin problems in people living with diabetes is thought to be high blood sugar. People with diabetes have too much sugar in their blood. This happens when they have a problem with their production of a hormone called insulin – that is, their bodies produce too little or no insulin – or when their cells don’t respond to insulin properly. If they don’t keep good control of their blood sugar levels – for instance by having a healthier lifestyle or taking medication regularly, it can, over time, cause a range of concerns.
 
One of the problems of having persistent high blood sugar levels is that you urinate more, which can leave you dehydrated (this may explain why one of the main symptoms of diabetes is feeling thirsty constantly). If you’re dehydrated, one of the things it can leave you with is dry or even very dry and cracked skin.
 
Having high blood sugar levels can also damage your blood vessels, which can lead to nerve problems (diabetic neuropathy). 
 
This happens because damaged blood vessels cannot transport oxygen and nutrients to your nerves effectively, so your nerves also become damaged and eventually die. If your blood vessels and nerves have been damaged it can affect your circulation, so the blood flow to your skin may not be as strong as it should be. Poor circulation can alter your skin’s structure, making it stiffer and less likely to heal effectively (slow healing is also a symptom of a weakened immune system, which can also be caused by persistently high blood sugar).
 
Damaged nerve fibres near the skin’s surface, meanwhile, can cause itching. So if your skin itches and you have diabetes, it’s probably a sign that your blood sugar is too high. In fact if you have diabetes and you’re experiencing any problem with your skin, it’s a good idea to talk to your doctor or a member of your diabetes care team about reviewing your diabetes management (this may lead to changing your medicine dosage, if you take any, or making additional healthy lifestyle changes).
 
Another problem that can happen if the nerves in your skin have been damaged is that you may lose sensation. This means you may not be able to feel pressure or heat, or you may not realise you’ve cut yourself because you can’t feel pain very well. This can often cause problems with the skin on your feet and lead to diabetic foot ulcers. 
 
People with diabetes can be affected by the same skin conditions as everyone else. They can also develop certain skin problems that usually only affect those with diabetes. Most of these conditions aren’t serious, but some can be persistent and uncomfortable, or even painful.
 

General skin conditions

Anyone can experience the following types of skin conditions, though people with diabetes are thought to be more susceptible to them than people who don’t have diabetes:
 

Bacterial infections

Skin can be affected by several types of infections caused by different types of bacteria, the most common of which is staphylococcus (or staph). These typically make your skin hot, red, swollen and painful. However they are easily treated with antibiotics.
 
Some bacterial infections that affect people with diabetes include:
 

• Styes (small, red lumps that appear on the edge of your upper or lower eyelid that can develop into little abscesses – find out more in our guide to what is a stye and how do I treat one?) 

• Folliculitis (Infections of the hair follicles)

• Carbuncles (deep infections of the skin and the tissue underneath)

• Nail infections

• Fungal infections – in people with diabetes these are typically caused by the yeast-like fungus Candida. These infections can affect areas including the genitals (thrush) and the mouth or throat (oral thrush), plus they can also cause havoc with your skin, causing itchy, red rashes between your fingers and toes, in your armpits, in your groin and under your breasts, as well as other places. Besides thrush and oral thrush, examples of fungal infections include athlete’s foot and ringworm.

 
Fungal infections can be easily treated with anti-fungal medication. Read more about them in our guide to Candida: causes & treatment.
 

Dry skin and itching

Itchy, dry skin isn’t unusual in people with diabetes. Infections such as fungal infections can make your skin itchy. But itching can also be caused by diabetic neuropathy, which is the term for nerve damage caused by persistent high blood sugar (the itching happens when the nerve fibres in the outer layers of your skin become damaged). Itching can also be caused by poor circulation, particularly when you experience it in the lower parts of your legs.
 

Psoriasis

A condition thought to affect around two to three per cent of the general UK population (iv), psoriasis causes red, raised, flaky scaly and often itchy patches of skin. Researchers have discovered there may be a link between psoriasis and type 2 diabetes (v), with those who have severe psoriasis having the highest risk of also developing diabetes. Experts elsewhere suggest nine per cent of people with type 1 and type 2 diabetes have psoriasis (iii). Find out more about this skin condition by reading our guide to psoriasis causes.
 

Skin tags

These are small, flesh-coloured growths that hang from the skin. They are common in the general population, but having a lot of skin tags can also be a sign of high blood sugar if you have diabetes. Also called acrochordons, skin tags don’t usually have any symptoms and are usually only removed for cosmetic reasons.
 

Acanthosis nigricans

This is a condition that makes areas of your skin – the sides of your neck, for instance, or in skin folds and creases such as your armpits or groin – dry and discoloured (it’s often said that the skin of acanthosis nigricans looks like velvet). Some people get lots of skin tags in these patches too. Being very overweight is the main cause of acanthosis nigricans, but it can also be a sign of type 2 diabetes or another condition such as an underactive thyroid or polycystic ovary syndrome (PCOS). Acanthosis nigricans can even be triggered by certain medicines such as hormone treatments (the contraceptive pill, for example) or steroid medicines.
 
If you haven’t been diagnosed with diabetes or any of the other conditions that can cause it, acanthosis nigricans can be a sign that your blood sugar is becoming too high or that you have prediabetes. 
 

Disseminated granuloma annulare

Granuloma annulare is an uncommon skin condition that causes groups of small, firm bumps in the skin that form a ring-shaped patch or patches. Disseminated granuloma annulare – a type of granuloma annulare – has been linked with diabetes, but it isn’t common. The patches can be itchy but they aren’t usually painful, and often heal without any treatment.
 

Diabetes-related skin conditions

There are also several skin conditions that only affect people with diabetes. Some of the main ones include:
 

Diabetic dermopathy

Caused by changes in the small blood vessels, diabetic dermopathy typically looks like light brown, scaly skin patches that are round or oval in shape. Studies suggest it affects 33 per cent of people with type 1 diabetes and 39 per cent of those with type 2 diabetes (iii), though you’re thought to be far less likely to experience it if you have well-controlled diabetes.
 
Most often affecting the front of the legs – usually the shins – diabetic dermopathy is often mistaken for age spots. The good news is that the patches aren’t itchy or painful, and no treatment is usually necessary, with the patches typically healing and disappearing on their own within one or two years.
 

Necrobiosis lipoidica diabeticorum

NLD is also thought to be caused by changes in the blood vessels. It causes spots on the lower leg similar to those of diabetic dermopathy, though they tend to be much larger and fewer in number, and they start out as raised, red, shiny patches. Like diabetic dermopathy, NLD patches are harmless but they can cause complications such as scarring, and they can make your skin more susceptible to infections. If they become more severe, it may be a sign that your diabetes isn’t being controlled adequately.
 
NLD, however, isn’t that common, affecting just 0.3 per cent of people with diabetes (vi).
 

Diabetic blisters

Also known as bullosis diabeticorum or diabetic bullae, these are irregularly shaped blisters or sores that develop on the hands and feet, and sometimes on the legs and forearms. They often affect people who have diabetic neuropathy, but they are usually painless and heal by themselves without scarring. They are quite rare, affecting around 0.5 per cent of people with type 1 diabetes, most commonly men and those who have been affected by peripheral neuropathy for a long time (iii).
 

Eruptive xanthomatosis

Typically caused by poorly controlled blood sugar levels, eruptive xanthomatosis is most often found on the backs of the hands, feet, arms, legs and buttocks, and looks like little yellow, pea-like spots, The spots or bumps – which can be itchy – have also been linked to high cholesterol and fat levels, and are thought to be more common in people with type 1 diabetes, particularly younger men. Eruptive xanthomatosis can, however, disappear if you achieve better control of your blood sugar.
 

Digital sclerosis

Around a third of people with type 1 diabetes are thought to experience this condition (i), which makes certain areas of skin tight, thick and waxy, sometimes with a texture like orange peel. Places you’re most likely to experience digital sclerosis include the backs of your hands, your toes and forehead, though the symptoms can spread to the arms, upper back, shoulders, neck and chest. Some people with digital sclerosis also find their fingers can become stiff and less mobile. The only way to treat digital sclerosis is to achieve better control of your blood sugar levels.
 

How can you prevent diabetes skin problems?

If you have diabetes, it’s arguably even more important than usual to take good care of your skin. However, the most effective thing you can do is to keep your diabetes well managed, as having uncontrolled blood sugar is generally the root cause of skin complications (see below for details of how you can support your blood sugar naturally). Find out more about ways to achieve better blood sugar control in our guides to diabetes causes and treatments and diabetes diet and lifestyle.


In the meantime, here are a few things you can do right now to help prevent diabetes-related skin problems:
 

• Take warm rather than hot showers or baths, as hot water can dry out your skin (showers are preferable to baths, as soaking can also make your skin dry). Also avoid using products that could irritate your skin such as bubble baths, shower gels and soaps. 

• After showering or bathing, dry your skin by patting gently instead of rubbing. Take extra care with skin folds and creases, including between your toes.

• Use mild, moisturising skincare products instead of those that contain harsh chemicals and other drying ingredients such as fragrances and dyes. These include soap substitutes for cleansing and medical moisturising creams and lotions called emollients. Moisturise your skin when it’s still damp after your shower. However avoid moisturising the skin between your toes, as this can help create the ideal conditions for a fungal infection. 

• Drink plenty of fluids to keep your skin hydrated too. Good options include water, milk, herbal and fruit teas (avoid sugary drinks and drinks loaded with caffeine).

• In winter, consider using a humidifier at home to add moisture to the air. You can also keep the air more humid by placing bowls of water near radiators.

• Check your skin every day for cuts and treat them quickly if you find any (ask your doctor to tell you how). Also check daily for any developing rashes, sores or infections, or areas of redness or inflammation, and talk to your GP as soon as you can if you spot anything. Check your feet daily too – find out how in our guide to diabetic foot ulcers  

• Try not to scratch if your skin itches as scratching too much can cause your skin to crack, which can allow infections to set in. Find out more about coping with skin itching in our guide to pruritus. 

 

Blood sugar support supplements

Taking your medication – if any – regularly and following your GP’s healthy lifestyle advice are considered the best ways to manage your blood sugar levels effectively. However some nutritional supplements have also been shown to help with blood sugar control – though please note, supplements should never be used as an alternative to the advice and medicines your GP or specialist gives you.

If you are taking any medication for diabetes it’s important to speak to your doctor before taking these or any other supplements, since some supplements could make your blood sugar too low (see our guide to diabetes for more about hypoglycaemia, which is a diabetes complication you may have heard of called hypos).

The first supplement you may want to think about taking is a good-quality multivitamin and mineral, as it can help make sure your body’s getting all the nutrients it needs to stay healthy. To find out more about multivitamin supplements and the variety of different formulations available, take a look at our guide to multivitamins and daily requirements.
 

Cinnamon

A natural remedy that’s been used in traditional Chinese medicine for centuries, cinnamon is a spice that’s also often recommended by natural therapists for people with type 2 diabetes, as there is some evidence it may help with blood sugar control (vii).
 

Alpha lipoic acid

There’s also evidence to suggest this fatty acid and powerful antioxidant could help control blood sugar levels (viii) as well as improve insulin sensitivity in people with type 2 diabetes (ix). However, if you have diabetes always consult your GP before taking alpha lipoic acid as it may enhance insulin activity.
 

Magnesium

Some researchers have found that people who have diabetes may have low magnesium levels (x), possibly because having diabetes or taking the medicines used to treat it may cause magnesium deficiency. Others have also discovered magnesium may even help with blood sugar control (xi).
 

Turmeric

Turmeric contains an active compound called curcumin that’s thought to have a number of potential health benefits, including the ability to reduce blood sugar levels (though to date most studies have been carried out in animals rather than humans, meaning the available evidence isn’t as strong as it could be). However, one study has found that curcumin may help improve blood sugar level control after investigating its effects in people with diabetic foot ulcers (xii).
 

High-strength fish oils 

Omega-3 fatty acids – particularly those found in oily fish such as salmon, trout, sardines and mackerel called EPA and DHA – are widely considered helpful for general health and wellbeing. According to the NHS, a healthy, balanced diet should include at least two portions of fish a week, including one of oily fish (xiii). But if you can’t or don’t like eating fish, a high-strength fish oil supplement may be a good option – or an omega oil supplement derived from marine algae instead of fish if you’re a vegetarian or vegan. 
 

Fenugreek

Fenugreek seeds have a long tradition of use in some parts of the world, including in Ayurvedic medicine. These days herbal practitioners often recommend fenugreek seeds to people with diabetes, as they may help the body to produce insulin. There’s also some evidence fenugreek seeds may be helpful in controlling type 2 diabetes and reducing insulin resistance, though supporting studies to date are small in scale (xiv). However, don’t take fenugreek if you’re pregnant or breastfeeding. 
 

Vitamin D

Vitamin D is probably best known for helping the body to absorb calcium. However, having low levels of vitamin D is being increasingly linked with type 2 diabetes (xv). Researchers are also examining the association between vitamin D deficiency and diabetic neuropathy – that is, diabetic nerve damage – with one small-scale study finding that people with type 2 diabetes and diabetic neuropathy have significantly lower levels of vitamin D than those who don’t have neuropathy and those who don’t have diabetes (xvi).
 
Unfortunately vitamin D deficiency is common, including in the UK. Public Health England advises adults and children over the age of one year old to consider taking a daily supplement containing 10mcg of vitamin D, particularly during autumn and winter (xvii).
 
However if your skin is rarely exposed to the sun – if you spend most of your time indoors, for instance, or if your skin is always covered when you’re out and about – you may need to take vitamin D throughout the year. People with dark skin from African, Afro-Caribbean and South Asian backgrounds should consider taking vitamin D all year round too, PHE advises.

The recommended form of vitamin D is vitamin D3 or cholecalciferol, as it’s the natural form of vitamin D that the body makes when it’s exposed to sunlight. Vitamin D3 supplements are available in tablet form, and now you can get them in veggie-friendly drops too. However most vitamin D3 supplements are made from the fat of lamb’s wool, which means they’re unsuitable for vegans. The good news is that vegan vitamin D3 supplements sourced from lichen are now more widely available.
 

High-strength anthocyanidins

The damage to blood vessels caused by consistently high blood sugar levels may make you more susceptible to skin problems. Supplements that contain plant substances called anthocyanidins however, help support blood vessel health. That’s because anthocyanidins – which are found in dark-skinned fruits such as blueberries, cranberries, raspberries, blackberries and red grapes as well as vegetables such as red cabbage, red onions and aubergines – protect collagen in the body (collagen is a structural protein that gives blood vessels their strength).
 
If you want to try an anthocyanidins supplement, look for one that also contains vitamin C,
as vitamin C supports the body’s ability to produce collagen.
 
 
Taking care of our skin is important for us all, but if you have diabetes it’s even more essential to be aware of the problems that can be triggered by your condition – and what that might mean in terms of how well your diabetes is being controlled. The good news is there are lots of ways you can care for your skin yourself, the most important of which is to keep your blood sugar well managed. Find out more about a variety of skin problems in our skin care pages, or take a tour around our pharmacy health library to discover more self-care advice for a wide range of health issues.

 

References:

(i) Available online: https://www.diabetes.org/diabetes/skin-complications
 
(ii) Available online: https://my.clevelandclinic.org/health/articles/12176-diabetes-skin-conditions
 
(iii) Duff M et al. Cutaneous Manifestations of Diabetes Mellitus. Clin Diabetes 2015;33(1):40-48. Available online: https://diabetesjournals.org/clinical/article/33/1/40/31293/Cutaneous-Manifestations-of-Diabetes-Mellitus
 
(v) Available online: https://www.psoriasis.org/psoriasis-statistics/
 
(v) Armstrong AW, Harskamp CT, Armstrong EJ. Psoriasis and the Risk of Diabetes Mellitus: A Systematic Review and Meta-analysis. JAMA Dermatol. 2013;149(1):84-91. Available online: https://jamanetwork.com/journals/jamadermatology/article-abstract/1377950
 
(vi) Kota SK et al. Necrobiosis lipoidica diabeticorum: A case-based review of literature. Indian J Endocrinol Metab. 2012 Jul-Aug; 16(4): 614–620. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3401767/
 
(vii) Mang. B, Wolters. M, Schmitt. B, et al. Effects of a cinnamon extract on plasma glucose, HbA, and serum lipids in diabetes mellitus type 2. Eur J Clin Invest. 2006;36:340-344. Available online: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2362.2006.01629.x

Akilen. R, Tsiami. A ,Devendra. D, Robinson. N, et al. Glycated haemoglobin and blood pressure-lowering effect of cinnamon in multi-ethnic Type 2 diabetic patients in the UK: a randomized, placebo-controlled, double-blind clinical trial. Diabet Med. 2010;27(10):1159-1167. Available online: https://onlinelibrary.wiley.com/doi/10.1111/j.1464-5491.2010.03079.x

Pham. AQ, Kourias. H, Pham. DQ. Cinnamon supplementation in patients with type 2 diabetes mellitus. Pharmacotherapy. 2007 Apr;27(4):595-9.Available online: https://accpjournals.onlinelibrary.wiley.com/doi/abs/10.1592/phco.27.4.595

Kirkham S, Akilen R, Sharma S, Tsiami A. The potential of cinnamon to reduce blood glucose levels in patients with type 2 diabetes and insulin resistance. Diabetes Obs Metab. 2009 Dec;11(12):1100-13. Available online: https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/j.1463-1326.2009.01094.x
 
(viii) Poh. ZX., Goh KP., A current update on the use of alpha lipoic acid in the management of type 2 diabetes mellitus. Endocr Metab Immune Disord Drug Targets. 2009 Dec;9(4):392-8. Available online: https://www.eurekaselect.com/article/30245
 
(ix) Evans JL, Goldfine ID. Alpha-lipoic acid: a multifunctional antioxidant that improves insulin sensitivity in patients with type 2 diabetes. Diabetes Technol ther. Autumn 2000;2(3):401-13. Available online: https://www.liebertpub.com/doi/10.1089/15209150050194279
 
(x) Elamin. A, Tuvemo. T. Magnesium and insulin-dependent diabetes mellitus. Diabetes Res Clin Pract. 1990;10:203-209. available online: https://www.diabetesresearchclinicalpractice.com/article/0168-8227(90)90062-X/pdf.

Barbagallow M, Dominguez LJ. Magnesium and type 2 diabetes. World J Diabetes 2015 Aug 25; 6(10):1152-57. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4549665/
 
(xi) Song. Y, He. K, Levitan. EB. Effects of oral magnesium supplementation on glycaemic control in Type 2 diabetes: a meta-analysis of randomized double-blind controlled trials. Diabet Med. 2006;23:1050-1056. Available online: https://onlinelibrary.wiley.com/doi/10.1111/j.1464-5491.2006.01852.x
 
(xii) Mokhtari M., Razzaghi R, Momen-Heravi M. The effects of curcumin intake on wound healing and metabolic status in patients with diabetic foot ulcer: A randomized, double-blind, placebo-controlled trial. Phytother Research: PTR (2020) 35(4):2099–107. Available online: https://onlinelibrary.wiley.com/doi/10.1002/ptr.6957
 
(xiii) Available online: https://www.nhs.uk/live-well/eat-well/food-types/fish-and-shellfish-nutrition/
 
(xiv) Yilmaz Z et al. Supplements for Diabetes Mellitus: A Review of the Literature. Pharm Pract 2017 Dec;30(6):631-638. Available online: https://journals.sagepub.com/doi/10.1177/0897190016663070.

Kassaian N et al. Effect of fenugreek seeds on blood glucose and lipid profiles in type 2 diabetic patients. Int J Vitam Nutr Res 2009 Jan;79(1):34-9. Available online: https://econtent.hogrefe.com/doi/10.1024/0300-9831.79.1.34 .

Gupta A, Gupta R, Lal B. Effect of Trigonella foenum-graecum (fenugreek) seeds on glycaemic control and insulin resistance in type 2 diabetes mellitus: a double blind placebo controlled study. Physicians India 2001 Nov;49:1057-61. Available online: https://pubmed.ncbi.nlm.nih.gov/11868855/
 
(xv) Berridge MJ. Vitamin D deficiency and diabetes. Biochem J. 2017 Mar 24;474(8):1321-1322. Available online: https://portlandpress.com/biochemj/article-abstract/474/8/1321/49583/Vitamin-D-deficiency-and-diabetes?redirectedFrom=fulltext
 
(xvi) Shillo P et al. Reduced vitamin D levels in painful diabetic peripheral neuropathy. Diabet Med 2019 Jan;36(1):44-51. Available online: https://onlinelibrary.wiley.com/doi/full/10.1111/dme.13798
 
(xvii) Available online: https://www.gov.uk/government/news/phe-publishes-new-advice-on-vitamin-d
 

 

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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

 

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