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Part I: Health-challenged Skin—Diabetes

By: Morag Currin
Posted: January 31, 2013, from the February 2013 issue of Skin Inc. magazine.

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Throughout time, diabetic clients develop skin complications from the long-term effects of diabetes on the microcirculation and on skin collagen. Infections in the skin are more common in type 2 diabetes, while autoimmune-related lesions are more common in type 1.

Diabetic clients who have had this disease for many years have a tendency to develop complicated skin problems. Skin problems can also arise in the short-term from insulin and oral hypoglycemic drugs. One of the biggest problems with diabetes-related skin lesions is that they may serve as a port of entry for secondary infections.

Skin issues from diabetes

Several of the skin problems that can be encountered by skin care professionals working with diabetic clients include the following.

Acanthosis nigricans. This condition presents as hyperpigmented, velvety plaques in body folds. The dark color is due to the thickening of keratin-containing superficial epithelium. Although these lesions are generally asymptomatic, they can be painful, smell bad, or soften and become thinner. The most effective treatment is a change in lifestyle, which includes weight loss and exercise to reduce insulin resistance. This condition is reversible with weight loss if it is seen as a complication of obesity. If the lesions are asymptomatic, they need no treatment. Ointments containing salicylic or retinoic acid can be used to reduce thicker lesions in areas of softness/thinning in order to decrease odor and promote comfort. Systemic isotretinoin improves acanthosis nigricans, but it recurs when the drug is discontinued.

Scleredema diabeticorum. This condition is characterized by a noticeable thickening of the skin on the back of the neck and the upper back, and can extend to the shoulders and lower back area. A peau d’orange appearance of the skin can occur, often with decreased sensitivity to pain and touch.