Diabetes a metabolic disorder affects many parts of the body, including skin. These  usually occur with uncontrolled blood sugar and are  reversible once the sugar is controlled.

With high blood sugar, one is more  prone to infections of the skin. Fungal infections cause discolored rounded or whitish discolored patches, which are associated with intense itching   This  can be localized or generalized.. Due to scratching,  secondary infection can occur resulting in boils. Infection by bacteria like staphylococcus or streptococcus viridans also results in painful  boils. These  can be a source of potentially serious infections and sepsis.

There can be thickening of the skin of the neck and upper back. This condition can be controlled by means of keratolytic agents and moisturizers, which soften the skin.

At times,  there can be  darkening of the skin, particularly in the skin folds,  under the armpits, back of neck, breasts or around groins. Obese people with diabetes are particularly more susceptible to develop this condition.  It looks bad cosmetically, but  is usually a benign condition.

The skin of the fingers and toes can also become waxy and   thick, causing some stiffness and pain. Keratolytic agents and moisturizers also help in providing relief in this condition.

Atherosclerosis is a condition where due to fat deposits, blood vessels tend to get obstructed, reducing the flow of blood  to body parts. Uncontrolled diabetes hastens this process, thus affecting the blood supply to limbs. Limbs become shiny and thin due to lack of essential nutrients brought by blood. Reduced blood flow also reduces the number of white blood cells reaching that site, which help fight infections. This makes an individual more prone to infections.  Wounds if present heal slowly.

 If  the blood lipid levels are also very high along with high blood glucose levels, a person can develop red colored halo like spots, particularly around, eyes and tendons of fingers.

Shiny, round or oval spots can appear on the shin of the legs due to impaired blood supply. These may be without any symptoms or may be associated with slight itching.

Due to  changes in the collagen and fat content underneath the skin, the overlaying skin area becomes thinned and reddened.  The  lesions are mostly  found on the lower parts of the legs and can ulcerate if subjected to trauma. The lesions have a fairly demarcated border. At times, they can be itchy and painful.

Rarely persons with advanced diabetes can develop blisters without any known trauma or burn. Such blisters usually occur on fingers, hands, forearms, toes  and legs. These  develop  due to reduced sensations  caused due to diabetic neuropathy. 

A person with diabetes can develop blisters easily   after pricks or injections or insect bites. These  if not punctured can result in secondary bacterial infections.

The best prevention for these skin problems is to keep the blood sugar under control. This can be achieved by means of dietary restrictions, anti-diabetic drugs and or insulin.

Even if any skin damage has started, it can be reversed by improving control of blood sugar as well as serum cholesterol if it is high.

A diabetic individual should always  keep his body, including hands and feet clean, soft  and dry.   Excess dryness should also  be avoided. He/ she should inspect hands and  feet daily for any sign of discoloration or blister or scaling. Medical treatment should be sought for any sign of skin affection.

Dr Rachna Pande is a specialist in internal medicine at Ruhengeri Hospital