By: Scott M. King
A great number of skin creams and lotions are formulated for, and marketed to, people with diabetes, but why? What is it that makes people with diabetes require skin care products, and why do those products need to be specifically designed for diabetics?
People with diabetes, for reasons that are not yet totally understood, are far more likely to develop skin complications. Once these problems set in, they can have serious consequences, including surgical tissue removal and amputation, if they are not cared for properly.
Why Do We Have More Skin Problems?
According to diabetic skin expert S. William Levy, MD, “Nobody really knows.” Levy first became interested in the subject in 1953, after finding a significant link between diabetes and amputations, and since that time he has worked at hospitals in the San Francisco area and written several articles on the subject for medical journals, as well as the book “Skin Problems of Amputees”
Levy says that many believe the root of diabetic skin problems lies in the narrowing of the small blood vessels near the skin (microangiopathy). These vessels protect and nourish the skin of nondiabetics, but, says Levy, “in people with diabetes, they become constricted and may even become completely clogged through the years.”
This restricted blood supply delays healing and increases the chances of infection. “When this happens, the tissues dry up and gangrene can set in, which may eventually lead to amputation. Remember, even simple bites and scratches can lead to ulcers [a deep sore on the surface of the skin],” he adds.
The Progression of Skin Problems
High glucose levels are probably the strongest contributing factor to neuropathy and poor circulation. This can result in dry, infection-prone skin. According to “The Johns Hopkins’ Guide to Diabetes,” dry, cracking skin “can also be caused by decreased sweat gland activity,” resulting from autonomic changes in sensation. The sensation loss that often accompanies neuropathy can prevent people with diabetes from realizing they have a skin problem developing.
The following is a rough outline of the progression of skin problems.
- dry skin
- skin cracks
- cracks allow infectious agents to enter the skin
- infection can take hold and spread
- wound doesn’t heal
- tissue breaks down, resulting in ulceration
- skin rots, and gangrene can set in
- possible internal infection
- amputation, additional surgery, and/or grafting may be necessary
To prevent these complications, a number of steps can be taken. One of the most important is to prevent dry and cracked skin. “When a person gets cracking between the toes or on the feet, it is very important to immediately obtain medication to close it up. Then, go to a podiatrist or dermatologist if it hasn’t healed in a few weeks,” says Levy.
“Another way to seal up cracks is by using an over-the-counter antibacterial ointment such as Polysporin or Bacitracin,” Levy points out.
What is the best step to prevent infection? “The overall thing is good hygiene,” says Levy. “First of all, use antibacterial soaps, also called deodorant soaps, like Lever 2000, Dial or Safeguard.
“And, for very dry skin,” Levy adds, “Dove, Purpose or Oil of Olay bars can be helpful. These soaps contain antiseptics to lower bacterial and fungal count on the skin.”
He adds that, for those with type 1 diabetes, “poor immunity to bacteria and fungi does not change, even if your blood sugar is controlled. There is an unknown relationship to susceptibility for people with type 1 diabetes, even when they have good control. Type 2 susceptibility, however, does hinge on control.”
Many of the lotions and creams for people with diabetes also contain infection-fighting ingredients. All of the creams and lotions in the Options section on pages 26 and 27 moisturize the skin to help prevent dryness and cracking.
What Is Urea?
You’ll notice in the Options section that many of the products use urea, which is a good moisturizer, binding water to the skin. It also loosens rough skin. It can exfoliate dry, callused tissue and stimulate new skin growth. But for some people, urea might be too strong to use every day on sensitive skin.
According to Levy, a product with 10 percent urea is fine for daily use, but higher levels might cause problems, because it can dissolve the outer layer of the nails. For example, dermatologists might use a level of 60 percent to remove an in-grown toenail or thickened fungal nail.
People react in different ways to skin cream ingredients. You might be allergic to one and get a rash, while another formula will make your skin soft and supple. You need to find the one that works best for you.
There are plenty of choices. Here is a list of skin care products designed for people with diabetes, along with comments from representatives of each company as to what sets its products apart from the competition.