Diabetes and the SkinDiabetes and the SkinJeff Goldes, M.D.Jeff Goldes, M.D.

Associated Dermatology of HelenaAssociated Dermatology of HelenaSt. Peters Hospital Consulting Staff PhysicianSt. Peters Hospital Consulting Staff Physician

Karrie Fairbrother, BSN, RN, RDCKarrie Fairbrother, BSN, RN, RDCSt. Peters Hospital Diabetic EducationSt. Peters Hospital Diabetic Education

President of the Dermatology Nurses’ AssociationPresident of the Dermatology Nurses’ Association

Lena Mortensen, PA-SLena Mortensen, PA-SUniversity of St. Francis Physician Assistant ProgramUniversity of St. Francis Physician Assistant Program

Common Diabetic Skin Common Diabetic Skin ProblemsProblems

►Bacterial infectionsBacterial infections CellulitisCellulitis FolliculitisFolliculitis

Common Diabetic Skin Problems Common Diabetic Skin Problems cont.cont.

►Fungal InfectionsFungal Infections Tinea pedis (athlete’s foot)Tinea pedis (athlete’s foot) Tinea cruris (jock itch)Tinea cruris (jock itch) Vaginal yeast infectionsVaginal yeast infections Onychomycosis (fungal infection of the Onychomycosis (fungal infection of the

nails)nails)

Common Skin Problems Cont.Common Skin Problems Cont.

► ItchingItching Often a result of yeast infection, dry skin, Often a result of yeast infection, dry skin,

and/or poor circulationand/or poor circulation

►Yellow NailsYellow Nails

Digital SclerosisDigital Sclerosis

►Tight, thick, waxy skin most commonly Tight, thick, waxy skin most commonly on the back of the handon the back of the hand

►Finger joints can become stiffFinger joints can become stiff11

Acanthosis NigricansAcanthosis Nigricans

►Hyperpigmented, velvety, Hyperpigmented, velvety, hypertrophic plaqueshypertrophic plaques

►Most commonly found in armpits, Most commonly found in armpits, neck, and groinneck, and groin22

Diabetic DermopathyDiabetic Dermopathy

►Caused by changes in the small blood Caused by changes in the small blood vesselsvessels

►Light brown, scaly, atrophic patchesLight brown, scaly, atrophic patches►Usually occur on the shinsUsually occur on the shins►Lesions do not itch, hurt, or Lesions do not itch, hurt, or

open upopen up11

Necrobiosis Lipoidica Necrobiosis Lipoidica DiabeticorumDiabeticorum

►Also caused by changes in blood Also caused by changes in blood vesselsvessels

►Similar to Diabetic Dermopathy but Similar to Diabetic Dermopathy but the spots are fewer in number and the spots are fewer in number and larger and deeperlarger and deeper

►Can be itchy, painful, and difficult to Can be itchy, painful, and difficult to treattreat11

Granuloma AnnulareGranuloma Annulare

►DisseminatedDisseminated

Pigmented PurpuraPigmented Purpura

►Often coexists with Diabetic Often coexists with Diabetic DermopathyDermopathy

►Macular instead of atrophicMacular instead of atrophic►Brown to red macules and patchesBrown to red macules and patches33

Diabetic Blisters (Bullosis Diabetic Blisters (Bullosis Diabeticorum)Diabeticorum)

►Most commonly on the backs of Most commonly on the backs of fingers, hands, toes, feet, and fingers, hands, toes, feet, and sometimes on legs or forearmssometimes on legs or forearms

►Look like burn blistersLook like burn blisters11

Eruptive XanthomatosisEruptive Xanthomatosis

►Firm, yellow, pea-like enlargements in Firm, yellow, pea-like enlargements in the skinthe skin

►Most often on backs of hands, feet, Most often on backs of hands, feet, arms, legs, and buttocksarms, legs, and buttocks11

Diabetic Foot UlcersDiabetic Foot Ulcers

►Diabetic NeuropathyDiabetic Neuropathy► InfectionsInfections

Peripheral Vascular DiseasePeripheral Vascular Disease

►Diabetics are more prone to develop Diabetics are more prone to develop atherosclerosis, which can result in atherosclerosis, which can result in peripheral vascular diseaseperipheral vascular disease11

ClaudicationClaudication Delayed healingDelayed healing Cold, pale, hairless legs and feetCold, pale, hairless legs and feet Thick nailsThick nails UlcersUlcers

GangreneGangrene

Prevention and Treatment of Prevention and Treatment of Skin ConditionsSkin Conditions

►Good News:Good News: The majority of the skin conditions The majority of the skin conditions

discussed can be prevented or treated by discussed can be prevented or treated by good blood glucose control!!!good blood glucose control!!!

Diabetic Foot ExamDiabetic Foot Exam

►Check feet daily for sores, ulcers, cutsCheck feet daily for sores, ulcers, cuts►Wear broad, flat shoes that fit properlyWear broad, flat shoes that fit properly►Check shoes for foreign objects before Check shoes for foreign objects before

putting them onputting them on11

Skin CareSkin Care

►Examine feet for sores, cuts, blisters, Examine feet for sores, cuts, blisters, etc.etc.

►Moisturize skin and use gentle soaps Moisturize skin and use gentle soaps when showeringwhen showering

►Treat cuts/breaks in skinTreat cuts/breaks in skin►Treat fungal infections of the feetTreat fungal infections of the feet►Keep skin dry and cleanKeep skin dry and clean11

ABCDE’s of Skin CancerABCDE’s of Skin Cancer

►Plus E for Plus E for

Evolution (change)Evolution (change)

Basal Cell CarcinomaBasal Cell Carcinoma

Squamous Cell CarcinomaSquamous Cell Carcinoma

MelanomaMelanoma

ReferencesReferences

1.1. Skin complications. American Diabetes Association. Skin complications. American Diabetes Association. Available at: Available at: http://www.diabetes.org/for-parents-and-kids/what-is-diahttp://www.diabetes.org/for-parents-and-kids/what-is-diabetes/skin-complications.jspbetes/skin-complications.jsp. Accessed February 7, 2008.. Accessed February 7, 2008.

2.2. Tschen JA, Tschen JA. Acanthosis nigricans. Tschen JA, Tschen JA. Acanthosis nigricans. Dermatology NursingDermatology Nursing. 2007;19:378.. 2007;19:378.

3.3. Huntley A. The skin and diabetes mellitus. Huntley A. The skin and diabetes mellitus. Dermatology Dermatology Online JournalOnline Journal. 1:1995. Accessed at: . 1:1995. Accessed at: http://dermatology.cdlib.org/DOJvol1num2/diabetes/vaschttp://dermatology.cdlib.org/DOJvol1num2/diabetes/vascular.html.ular.html.