Individuals with diabetes (a metabolic disorder with high blood sugar), are more susceptible to many problems including disorders of the skin. These disorders usually occur with uncontrolled blood sugar and are reversible once the sugar is controlled.When the blood sugar is high, one is more prone to infections of the skin. Fungal infections cause discolored rounded or whitish discolored patches, which are associated with intense itching depending on the level of uncontrolled blood sugar and duration of infection, the fungal infection can be localized or generalized.Due to scratching, one may get secondary infection resulting in boils. Infection by bacteria like staphylococcus or streptococcus viridans also results in boils. These boils are painful and 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, which soften the skin and moisturizers.At times, diabetic individuals develop darkening of the skin, particularly in the skin folds. It may develop under the armpits, back of neck, breasts or around groins. Obese people with diabetes are particularly more susceptible to develop this condition. Though it looks bad cosmetically, but it 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 build up of plaques of fat, blood vessels tend to get obstructed, reducing the flow of blood, hence blood supply to body parts. Uncontrolled diabetes hastens the process of atherosclerosis, 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 and wounds if present heal slowly.Sometimes, when 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, tendons, back and buttocks.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. Necrobiosis lipoidica diabeticorum (NLD) is a condition   thought to be caused by 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 which resemble blisters of burns. 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 keep his body, including hands and feet clean, soft and dry always.  Excess dryness should be avoided. He or 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 internal medicine-Ruhengeri Hospital