Diabetes mellitus is an increasingly common systemic disorder that may present with an assortment of accompanying skin problems. These skin manifestations may directly result from blood sugar abnormalities, or may be complications of various disorders such as kidney failure, microangiopathies and nerve damage. Physical changes in the skin of diabetic patients can vary from the mundane, such as skin dryness, to serious and lifethreatening, such as chronic ulcers or skin infections.

Some of the more common skin problems seen in diabetics are:

1. Dry/itchy Skin. Increased fluid loss due to elevated blood sugar levels can dry out the skin. This can result in scaling, cracking, and fissuring. Breaks-in the skin can then allow bacteria or germs to enter leading to local infections. Dryness of the skin also contributes to severe pruritus or itching.
2. Thick Skin. Diabetics tend to have thicker skin compared to non-diabetics. This thickening is often observed in the knuckles and forearms. Hardening of the skin in the shoulders, nape and upper back areas (known as scleredema of diabetes) may also be a consequence. This may cause limitation of movement of the upper extremities.
3. Yellow Skin. The skin of diabetics often takes on a yellowish hue. This alteration is often more apparent in the palms and soles. However, aside from being aesthetically unappealing, these changes are largely innocuous.
4. Nail Changes. Yellowing, thickening and cracking of the nails are also seen with great frequency in diabetic patients. These nail changes should be scrutinized for possible coexistent fungal infections. Unusual thickening or contour lead to ingrown nails which predispose to puncture wounds and infections in the adjacent skin areas.
5. Yeast/Fungal Infections. Fungal infections of the genital areas and skin folds are also frequently seen in diabetics. Almost all potentially moist areas such as the webs of the hands and feet may also be affected. These manifest as red, scaly, macerated, damp and extremely itchy patches of skin. If not addressed, these may enlarge and involve the deeper layers of the skin, with secondary bacterial overgrowth.
6. Dark Spots. The skin on the lower extremities of diabetic patients is also commonly affected, particularly on the shins. These changes manifest as multiple dark deep spots or patches (known as diabetic dermopathy), hair loss, cold toes, nail changes, edema or skin mottling.
7. Calluses and Ulcers. Nerve damage in diabetics predispose to the formation of calluses in weight-bearing areas, notably on the feet. The decreased sensation in the involved regions coupled with trauma sustained from ill-fitting footwear contribute to the subsequent development of skin ulcers.

In summary, the skin problems associated with diabetes mellitus are numerous and varied. As with most conditions, prevention, vigilance and early detection are crucial in the management of these changes. Educating diabetic patients and their caregivers regarding these complications forms an integral part of care.

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