Authors: Dr. Anuradha kapoor

ABSTRACT:

Diabetes is the disease which can affect every part of the body, including the skin. About a third of people with diabetes will develop skin problems at some point. In fact, some skin conditions can be a presenting symptoms of diabetes and they are diagnosed as a case of diabetes because of thses symptoms. Most of the skin conditions that affects diabetic patients can be treated easily, if they’re diagnosed and treated early. As with any diabetes related disease the most important part of treatment is strict glycemic control. After that only we can treat skin problem completely.

INTRODUCTION:

Cutaneous disorders associated with diabetes mellitus (DM) are thought to occur in about 30% of patients during the course of their disease, but a recent study has documented prevalence rate of skin diseases to be 60% in (unselected) diabetic subjects consecutively attending an outpatient clinic. Cutaneous manifestations generally appear subsequent to the development of diabetes, but may be the first presenting sign or even precede the diagnosis by many years.The cutaneous findings can be classified into four major groups:

1. Skin diseases associated with diabetes, such as
• Necrobiosislipoidica
• Diabetic dermopathy and
• Diabetic bullae
2. Cutaneous infections
3. Cutaneous manifestations of diabetic complications, such as
• Neuropathic foot ulcers and
4. Skin reactions to diabetic treatment.

MECHANISM : The cutaneous signs of diabetes are the manifestations of multiple factors.

• Abnormal carbohydrate metabolism and Other altered metabolic pathways,
• Atherosclerosis,
• Microangiopathy,
• Neuron degeneration, and
• Impaired host mechanisms all play a role.

EFFECT OF DIABETES ON SKIN: Some of the skin related smptoms and signs are:

• Dry, itchy skin
• Slow healing of even minor cuts and wounds.
• Loss of peripheral sensation in the foot making it prone to formation of corn ,callus and ulcers that later becomes one of the most difficult to treat conditions of diabetic patients and in severe cases leading to loss of foot due to amputaions.
• Skin infections: poor glycemic control make them prone to skin infeactions due to various organisms like fungal(candida) and bacteria infeaction.
• There is Loss of skin elasticity and tone from dehydration and poor blood circulation
• There is Increased sensitivity to sun and ultraviolet light

TABLE1: Diabetes mellitus and skin manifestations

Necrobiotic disorders Necrobiosislipoidicadiabeticorum Disseminated Granuloma annulare	Miscellaneous Diabetic bullae Genital pruritus Acanthosisnigricans Skin tags Vitiligo Perforating dermatoses Lichen planus Nail disorders Hair disorders
Vascular changes Diabetic dermopathy Diabetic foot
Changes in collagen and skin constituents Diabetic thick skin: Asymptomatic thickness of skin Scleredemadiabeticorum Limited joint mobility and waxy skin Dupuytren's contracture Infections Bacterial Candidiasis Dermatophytosis Erythrasma	Metabolic disorders Eruptive and other xanthomata contractureCarotinemia Porphyria cutaneatarda Hemochromatosis Rare syndromes Werner's syndrome Partial lipodystrophy Glucagonoma(described under secondary diabetes)
Neuropathy Trophic ulcer Pathological gustatory sweating Peripheral neuropathy	Reactions to antidiabetic drugs Sulfonylureas Biguanides Insulin

TABLE 2: Virtually diagnostic markers of diabetes mellitus

Diabetic bullae

Syndrome of limited joint mobility and waxy skin

Diabetic dermopathy

PREVENTIVE MEASURES:

From the dermatological point of view Here are some ways you can prevent skinproblems:

1. Most important of all strict glycemic control: keep your blood sugars within normal range.
2. Daily skin care: Wash your skin with a mild soap don’t scrub much, dry it completely Then apply a good quality moitsurizers to Keep your skin moist by using it after you wash. You should use a fragrance-free and dye-free moisturiser. Apply lip balm to prevent chapped lips. Use proper sunscreen as advised by your doctor to avoid further damage of skin texture.
3. Avoid very hot baths and showers, which can dry your skin. Extended exposure to water softens the feet and makes your skin more prone to being pierced.
4. Inspect your body for red spots, blisters and sores that could lead to infection.
5. Take proper care of your foot: as advised by your diabetologist. Check them every day for sores and cuts. Wear proper footware ,Wear broad, flat shoes that fit well. Check your shoes for foreign objects before putting them on. Look for any bumps or changes in appearance on your feet .Immedialetly consult your doctor if you get even a small cuts don’t treat it yourself.Wash minor cuts with soap and water.
6. Control of comorbid conditions are necessary as a part of prevention: Control blood pressure and cholesterol by taking prescribed medications, which will improve circulation and keep your skin healthy.
7. Drink plenty of fluids, like water and caffeine-free, sugar-free drinks, to keep your skin hydrated.
8. Eat foods rich in Omega-3 fatty acids, which nourish the skin. This includes fish like salmon, sardines, tuna and mackerel, as well as tofu and other forms of soybeans, walnuts, flaxseed and their oils.
9. You are far less likely to develop skin problems if you take good care of your skin, and have healthy blood glucose, blood pressure and blood cholesterol (lipids) levels. See a dermatologist about skin problems and don't wait too late as in diabetes, the healing time is slow. Prevention as they say is better than prolonged medication.

CONCLUSION:

Diabetes affects almost every part of body including skin and causes premature aging of skin. Skin affection is either one of the presenting symptoms of diabetes mellitus or patient may presents as a case of diabetes mellitus with skin involvement as a long term complications of diabetes mellitus. So as is true with prevention is better than cure skin affection as well as aged appearnace of skin can only beprevented by taking required preventive measures as described above briefly, to make skin look more youthful and healthy.