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A disease that makes your skin crawl

A disease that makes your skin crawl

Due to their disease, diabetics do not just have to battle a potential disturbance in their sugar metabolism. In addition, the disease can also result in severe skin disorders, which often can only be controlled through medical care.

Skin needs moisture

Typically, diabetics suffer from dry skin, since moisture gets lost through the increased water excretion – Pruritus (itching) all over the body is often the result. That’s why the general care should include adequate personal hygiene with moisturizing lotions. A first indication of a possible diabetes affliction could also be recurrent Candida infections, since diabetics also excrete sugar through the skin which forms an ideal nutrient medium for several bacteria. Next to oral thrush, in particular the genitals are often affected (for example Balanitis, an inflammation of the glans penis in men) as well as poorly ventilated areas of the skin.

 
 
 

Generally, diabetics themselves are not informed about possible skin diseases and therefore when in doubt would at first turn to a dermatologist without notifying their attending diabetologist. A patient briefing that diabetes and poorly controlled blood sugar, respectively, are also associated with several skin diseases, should therefore take place through the diabetologist.

 
 

While skin diseases of course also occur in non-diabetics, there are a number of skin disorders that frequently occur above average in diabetics. Better known are certainly polyneuropathies such as the Burning feet syndrome or a diabetic foot. Yet also granulomatuous changes like Granuloma annulare disseminatum*, diseases of the connective tissue like Bullosis diabeticorum or “limited joint mobility“ belong in this group. The latter two diseases more often affect diabetics who have been afflicted for several years. While in the case of Bullosis diabeticorum, blisters virtually occur overnight on the extremities and can reach several centimeters in diameter and then heal spontaneously, the problems of limited joint mobility often persist and in the worst case scenario need to be surgically corrected. In addition, with diabetics often the hands are being affected, so a quick diagnostic investigation and treatment is necessary to maintain quality of life.

 
 

Photo: Hands put together - Stiff Hand Syndrome

 
 

Well-controlled is half the battle

When asked on the subject of skin diseases in diabetics, one diabetologist of a university hospital answered that he does not see such cases, since the only patients that visit him are actually so well controlled to where skin disorders are virtually not a problem. However, this is just one side of the coin, because oftentimes the path of a poorly controlled diabetic with skin problems leads him/her initially to a dermatologist. For instance they go to Professor Peter Altmeyer from the Department for Dermatology, Venereology and Allergology St. Josef-Hospital, Ruhr University Bochum, Germany:”Diabetes mellitus results in a modified metabolic status, whereby individual organs are being changed in their function. This can lead to problems with the skin if the diabetes for example is not well-controlled, although not all skin diseases that we see in diabetics correlate with the height of the blood sugar level. Yet there is a ‘diabetic metabolic status‘, which causes problems with the skin – for example infections of a bacterial and mycotic nature. But in general we can treat these very well. More difficult in comparison are circulatory disorders in the skin. “

 
 
Photo: Hand in gloves investigates foot with nail fungus 
Diabetics very often have to
battle nail fungus. Here a defini-
tive mycotic treatment is shown;
© panthermedia.net/Andrea Kübler

Here the peripheral arterial occlusive disease (PAOD), also known to many patients as “shop-window disease“ needs to be mentioned. The disease progresses slowly and is normally not being noticed or is misinterpreted in the beginning stages, for instance as a rupture of a muscle fiber due to pain in the calves. What makes this more complicated for diabetics is that their sensitivity to pain in the feet can be restricted by a polyneuropathy so that even open wounds and abscesses cannot be sensed. The consequence is a severe progression and a drawn-out treatment of the patient.

Skin diseases can indicate possible diabetes

Aside from diabetics that develop problems with their skin there are also those patients who don’t find out about their Diabetes mellitus affliction until they acquire skin disease. Professor Altmeyer explains:”The skin disease can already show a dermatologist that a disturbed blood sugar level is present. The example of Necrobiosis lipoidica, a disease which we know occurs more often in diabetics should be mentioned here. Xanthomas, which are accumulations of lipids in the skin, are more often combined with Diabetes mellitus. “Necrobiosis lipoidica are inflammations of the skin which manifest themselves through red papules along the calves. In poorly progressing cases, an abscess can develop.

Allergic reactions to insulin are possible, but rare

Another problem for diabetics, as it is for almost all chronically ill people who need drugs over a longer period of time, can be the resistance to a specific insulin. ”There can be varying reactions to insulin: For instance there are circumscribed granuloma formations, which are hardenings at the injection sites or dents, because the fat tissue melts at the site of injection. What’s more, in rare cases a patient can have an allergic reaction to the insulin and respond with a rash. In these instances, you need to switch the insulin. “Based on improved manufacturing techniques, the latter – insulin contaminations hardly exist anymore – has become rarer. A switch to another insulin product in general is sufficient to stop the discomfort, since the reaction in most cases is not related to the insulin itself, but rather to the associated substances of the medication. In terms of possible granulomas at the injection sites – which often occur in long-term diabetics – regular change of injection sites is being recommended.

Interdisciplinary collaboration is most important

Ultimately diabetics who suffer from skin problems, should count on as close a collaboration between their physicians as possible. Interdisciplinary consultation hours, like the ones that are being offered by different hospitals, are helpful in these cases. Professor Altmeyer also counts on a great collaboration in his clinic and the exchange among colleagues:”For example, this works wonderfully in the combination ‘skin and vascular diseases‘ or ‘skin and ulceration‘. In such cases surgeons, dermatologists and for instance bacteriologists work closely together. “Patients generally can receive information on consultation via the homepages of the individual clinics.


 
 

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*granulomatuous inflammation of skin, characterized by red papules


Simone Ernst
MEDICA.de

(Translated by Elena O'Meara)

 
 

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