S. William Levy, MD, is a dermatologist with more than 50 years of experience treating diabetes-related skin conditions.
We caught up with Dr. Levy recently and invited him to answer questions frequently asked bypeople with diabetes about their skin.
Why do people with diabetes tend to have a higherincidence of skin complications?
Nobody really knows, but many believe it is due to anarrowing of the smaller blood vessels near the skin(microangiopathy). In nondiabetics, these smallerblood vessels protect the skin. But in people withdiabetes, these vessels become constricted andeventually may even become completely clogged.
Because of the restricted blood supply, woundsdon’t heal very quickly, which can lead to infection.When this happens the tissues dry up and gangrenecan set in, which may eventually lead to amputation.Remember, even simple bites and scratches can leadto ulcerations (sores on the surface of the skin).
Why are the feet a focal point when it comes todiabetes-related skin problems?
Because of the occluded blood vessels. Thecirculation is poorest around the toes and on the feet,causing bacterial and fungal infection. People withdiabetes also tend to have less feeling in their feet andtoes. Due to the loss of protective sensation, they maybe unaware of a cut or blister and will ignore it until,often, it becomes much worse.
The diabetic foot is the result of systemic changesassociated with increased blood glucose, which cancause the classic triad of neurological, vascular andimmune system deficits that can ultimately result inamputation.
What kind of precautions can people withdiabetes take to reduce their risk of skinproblems?
Maintain good hygiene and check the skin, andespecially the feet, every day.
First of all, use antibacterial soap, also calleddeodorant soaps. These include Lever 200, Dial andSafeguard, all of which contain antiseptics to lowerthe skin’s bacterial fungal count. Bacterial infectionsneed to be treated early and aggressively to preventprogression. In addition to these soaps, appropriatetopical or oral antibiotics can be used when indicatedby a physician.
How can fungal infections be avoided?
Zeasorb powder and Sarna lotion are antifungal over-the-counter treatments used for this purpose. Femalepatients can use them under their breasts to preventfungal infections there. Both of these products will helpdry the skin in the groin area as well.
Also, avoid having the cuticles pushed back whengetting a manicure, as this can cause possible yeast orfungal infections.
Poor immunity to bacteria and fungi does not improveeven if the blood glucose is controlled. There is anunknown relationship to susceptibility for people withtype 1 diabetes—even when they have good control.Type 2 susceptibility, however, does hinge on control.Over-the-counter antifungal creams are available ifathlete’s foot is active.
What kinds of lotions do you recommend to treatskin problems?
Creams are okay as long as they don’t irritate the skin, but every individual is different. If a person gets cracks on the skin of the feet, creams can seal them up. Two suggested products are Am-Lactin and Eucerin, whichare all sold over the counter.
Another way to seal up cracks and to prevent or treatbacterial infections is to use antibacterial ointments.During the winter months, when there is crackingbetween the toes or on the feet, it is very importantto immediately start using a lotion to help close themup. Seek help from a podiatrist or dermatologist if thecracks are not healed within a few weeks.
What kinds of socks should people with diabeteswear to help control foot problems?
Stay away from pure nylon, dacron and wool socks.They can irritate some skin and cause excessivesweating, which causes cracks and fissures. Peoplewith diabetes should stick to cotton or cotton blends,and change them frequently when moist.
What else do people with diabetes need to knowabout skin care?
People with diabetes should protect themselves fromthe sun and should teach their children to do the same.They should teach their children at a young age toalways wear a hat in the sun and to wear sunscreenevery day (even on cloudy days) to prevent skin cancerin later years. Sunscreens are available with sunprotective factors (SPF) ranging from 8 to 50. An SPF ofat least 15 or 30 is recommended for daily use.
S. William Levy, MD, is a clinical professor of dermatology at the University of California San Francisco Medical Center. A solo practitioner who writes for medical journals about skin complications of amputees related to diabetes, he is also author of the book “Skin Problems of Amputees.” He has no financial interest in any of the products mentioned in this article.