Diabetes and the Skin

The Skin and Its Important Functions

With an average surface area of about two square meters, accounting for one-fifth of body weight and one-quarter of body water, and containing around 600,000 cells, 1 meter of blood vessels, and 4 meters of nerve pathways per square centimeter—these figures illustrate that the skin is the largest organ of the human body.

It performs numerous essential functions. A selection:

1) Separation of the internal and external environment

  • Protection against harmful external influences such as pathogens, radiation, or pressure (cushioning by subcutaneous fat tissue)
  • Protection against dehydration
  • Regulation of body temperature

2) Organ of contact and sensation

  • Perception of pain, temperature, and touch
  • Psychological reactions (e.g., blushing due to embarrassment, lie detection)

Diabetes-Related Skin Changes

Diabetes-Related Skin Changes

  • Four out of five people with diabetes suffer from skin changes.
  • These lead to symptoms such as rough, itchy, and cracked skin, impairing normal skin functions.
  • Consequences include fissures, athlete’s foot, and poorly healing wounds.
  • The lower legs and feet are particularly affected; these changes are a key component of the diabetic foot syndrome.

Causes (interrelated and well established):

1) Dryness

  • Sweat and sebaceous glands no longer function properly due to nerve damage
  • The skin’s acid mantle fails → altered bacterial colonization → infections
  • Reduced elasticity → cracks and fissures

2) Nerve Damage (Neuropathy)

  • Affects sensory, motor, and autonomic nerves
  • Injuries or stress (heat, pressure, foreign bodies) are not perceived → delayed treatment
  • Muscle atrophy leads to deformities (e.g., hammer toes)
  • Sweat gland dysfunction impairs thermoregulation

3) Circulatory Disorders

  • Reduced oxygen and nutrient supply
  • Can lead to bone demineralization (osteoporosis) and fractures → further stress on the skin

4) Abnormal Mechanical Stress

  • Deformities cause excessive pressure in wrong areas
  • Loss of fat padding and elasticity reduces natural protection

Consequences of Diabetes-Related Skin Changes

  • Increased susceptibility to bacterial and fungal infections
  • Poor blood sugar control accelerates and worsens infections (“fuel to the fire”)
  • Typical bacterial infections: erysipelas, boils, abscesses
  • Typical fungal infections: nail fungus, Candida infections

Key point:
Early professional treatment is crucial, but prevention is even more important—especially through proper foot and skin care.

Skin Care

Goals:

  • Restore moisture and lipids
  • Rebuild the skin barrier

Recommendations:

  • Use mild, pH-neutral products; urea for very dry skin
  • Seek advice from trained professionals

General rules:

  1. Foot baths should be short (<5 minutes) and temperature-controlled (use a thermometer).
  2. Apply care products daily after washing and thorough drying (including between toes).
  3. Inspect feet daily for wounds, pressure points, discoloration, or infections.
  4. If self-care is difficult, medical podiatry treatment may be prescribed.
  5. Avoid sharp tools for nail and callus care.
  6. Seek professional help for corns, fungal infections, or wounds immediately.
  7. Proper footwear and insoles are essential preventive measures.

Diabetes-Associated Skin Diseases

  • Must be distinguished from direct complications
  • Examples:
    • Vitiligo (depigmented patches)
    • Necrobiosis lipoidica (reddish lesions, often on shins)
  • Injection site changes may occur with insulin therapy
    • Rare: lipodystrophy
    • Common: fat tissue thickening and scarring (preventable by rotating injection sites)

Regular inspection of injection sites should be part of routine diabetes care.

References (Scientific & Medical Sources)

  1. World Health Organization – Diabetes overview and complications
  2. International Diabetes Federation – IDF Diabetes Atlas and skin complications
  3. American Diabetes Association – Standards of Medical Care in Diabetes
  4. National Institute of Diabetes and Digestive and Kidney Diseases – Diabetic neuropathy and skin issues
  5. Dermatology textbooks (e.g., Fitzpatrick’s Dermatology)
  6. Endocrinology literature on diabetes complications
  7. Boulton AJM et al. “The Diabetic Foot” (Lancet, peer-reviewed article)
  8. Edmonds M., Foster A. Managing the Diabetic Foot (clinical reference)
  9. American Academy of Dermatology guidelines on skin care in diabetes
  10. German Diabetes Society (DDG) clinical guidelines on diabetic foot syndrome