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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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Skin tags. These are small, stalklike, soft, often-pigmented lesions occurring on the eyelids, neck and underarm area. Treatment is not necessary, but skin tags can be removed with cryotherapy or electrodessication. They may be a sign of impaired glucose tolerance, diabetes and increased cardiovascular risk.

Skin-thickening. This may increase with aging diabetic clients. At first, this condition is generally asymptomatic, but there is measurable thickening that often becomes apparent in the skin on the fingers and hands. There is also a form of thickening called diabetic scleroderma, where the dermis of the upper back becomes noticeably thickened. The thickening of the skin on the hands may occur with 20–30% of all diabetic clients, regardless of the type of diabetes from which they suffer. Skin manifestations can range from pebbled knuckles to diabetic hand syndrome. Pebbled knuckles manifest through multiple minute papules found on the fingers, especially where they are stretched or straightened out on the knuckles. Stiffness is common with diabetic hand syndrome, and it can start to limit joint mobility. Skin on the hand may also present as waxy.

Vitiligo vulgaris, or hypopigmentation. This occurs more often during type 1 diabetes. These clients should be advised to avoid the sun and to use broad-spectrum sunscreens at all times, particularly in the areas hypopigmentation is occurring.

Professional responsibility

When a diabetic client considers professional skin care treatments, there will always be questions, such as: “Does the skin care professional know anything about diabetes?” and “Can she safely perform a spa treatment on a diabetic client?” One of the biggest concerns with diabetes is neuropathy, due to a lack of feeling in localized areas during electrolysis, pedicures and waxing. Clients need to be asked if they are aware of any open wounds, especially on the hands and feet. Also, it is crucial to use and recommend products with beneficial ingredients for this condition. (See Beneficial Ingredients for Diabetic Clients.)

Ask your diabetic clients if they have a continuous glucose meter (CGM) placed into their skin. These cannot be used in and around water. Also ask when insulin was last taken, because skin care treatments should not be performed during the peak of insulin activity. Intermediate-acting insulin taken in the early morning allows for a safe spa treatment mid-afternoon, whereas rapid-acting insulin allows for a safe spa treatment approximately one-to-three hours after administration.