Most of us take our skin for granted. This remarkable organ is responsible for many important functions, such as being our first line of defense against harmful bacteria and fungi.

If you have diabetes, your skin needs special care to make sure it stays healthy. At some time in their lives, about one-third of people with diabetes will have a skin condition that is either caused by, or adversely affected by, their diabetes.

While most people with diabetes know that regular foot care is essential for them, skin care often gets overlooked. Serious problems, and even permanent damage can occur if skin problems aren't recognized and treated properly.

There are skin conditions that occur specifically in people with diabetes, such as diabetic dermopathy, diabetic blisters, digital sclerosis, and several others. Controlling blood glucose levels can prevent or minimize many of these conditions. In addition, people with diabetes are more susceptible to common bacterial and fungal skin infections that can affect anyone.

Diabetes can cause microscopic changes in blood vessels and nerves, and dehydration. Each can make it easier to get infections, and more difficult to detect and treat them. Without proper care, skin problems can turn serious and might cause permanent damage. All of this costs more in time and money as more prescription medications and medical attention is needed to clear up the complications.

Diabetes, if not properly treated, can harm the body in many ways. The skin is no exception. Most skin problems can be avoided by keeping your glucose levels under control. Complications of uncontrolled diabetes include:

Dehydration, which can cause dry skin. Dry skin may crack and peel, making it easy for harmful organisms to enter. Dry skin is also itchy skin, and scratching can lead to infection.

High glucose concentrations in the skin tissue. Glucose provides an excellent breeding ground for bacteria and fungi, as well as reducing the effectiveness of the body to repair itself.

Increased risk for diabetic neuropathy, where nerves are damaged and there is a loss of feeling. Diabetic neuropathy greatly increases the risk of undetected injury, which can lead to infection, skin ulcers, or even gangrene.

If your diabetes is not well controlled, your first step is to speak with your physician or health care provider. Your provider can establish a proper treatment plan to lower blood glucose, and keep complications to a minimum.

Skin care should be a regular part of managing your diabetes. It is estimated that at least half of all diabetes-related lower extremity amputations could be prevented through proper education and self-care. Follow these tips for proper skin care:

• Avoid showers and baths that are too hot.
• Bathe regularly using a mild soap such as Basis, and rinse well.
• Avoid bubble baths, which often contain drying detergents.
• After bathing, dry thoroughly. Be sure to give extra attention to folds of skin where excess moisture can accumulate, such as underarms, groin, and between toes. Excess moisture in these areas can increase risk of a fungal infection.
• After skin is dry, use a moisturizing lotion, such as Lubriderm, CVS Lotion , or Keri , concentrating on areas where skin is driest. Avoid those places (underarms, groin, and between toes) where excess moisture can cause fungal growth.
• Avoid skin products containing alcohol.
• Drink plenty of fluids to keep your skin hydrated.
• In cold, dry climates, keep your home more humid with a humidifier such as Duracraft.
• Wear a good sunscreen. Besides protecting the skin from sunburn that can lead to blistering and peeling, regular use of sunscreen lowers your risk for skin cancer.
• Use proper infection control methods when injecting insulin, and inspect injection sites for any sign of infection.

The occasional cut or scrape is almost unavoidable. People with diabetes need to pay special attention to minor wounds in order to prevent infection from setting in. Minor cuts and scrapes should be treated right away:

• Wash with soap and warm water as soon as possible. A few popular, gentle soaps include Basis, CVS, or Dove
• Do not apply alcohol or antiseptics that contain iodine.
• Use an antibiotic cream only on the advice of your health care provider.
• Keep the area protected by covering with a sterile bandage or gauze, such as Band-Aids or CVS Flexible Fabric Bandages.
• Contact your health care provider right away if you suffer from a serious cut or burn.

Inspect your body regularly, and report any of the following to your health care provider:

• Changes in skin color, texture, or thickness
• Any lesions or blisters
• Early signs of bacterial infection, such as redness, swelling, boils, or skin that is warm to the touch
• Itching in the groin, vaginal or anal area, under the arms or breasts, and between the toes, which may signal a fungal (yeast) infection
• A wound that does not heal

Your health care provider can recommend the best treatment option based on your medical history and the skin involved.

1. Funnell,MM,Haas,LB, "National Standards for Diabetes Self-Management Education Programs," Diabetes Care, January 1995, pp 100-116.
2. Levin, ME, Pfeifer, MA, The Uncomplicated Guide to Diabetes Complications, American Diabetes Association, 1998, p.266
3. "Prevent Diabetes Problems: Keep Your Feet and Skin Healthy," National Institute of Diabetes, Digestive, and Kidney Disease, n.d., (www.niddk.nih.gov/health/diabetes/pubs/complications/feet/feet.htm) October 11, 2000.
4. "Skin Care and Common Skin Problems," American Diabetes Association, n.d., (www.diabetes.org/ada/c70b.asp) October 11,2000
5. "Skin Care: An Essential Part of Your Health", Roche Diagnostics, (diabetes.roche.com/features/featureMay99.html) n.d., October 10, 2000
6. Steil, FS, Campbell, K, White, JR, "Diabetes Care Products and Monitoring Devices," APhA Handbook of Nonprescription Drugs, APhA, Washington D.C. 1996, p. 338.

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