Diabetes and Winter Skin Care

Understanding diabetes-related skin issues

Diabetes-related changes in circulation can contribute to the breakdown of collagen—the protein that gives structure and firmness to skin, and to all of the body’s connective tissues. This changes skin's appearance, texture, and ability to heal. Cold weather and dry air exposure may leave your skin even more vulnerable, particularly to infections.

These skin issues are more common than many people realize: A recent study of 750 patients with diabetes found 79% had a skin disorder present at the time of their clinic visit. This means nearly four out of five people with diabetes being seen in outpatient clinics had diagnosable skin problems. The most common problems were skin infections, xerosis (abnormally dry skin), and inflammatory skin conditions, such as psoriasis and eczema.

Prioritize your skin

If you have diabetes, it’s important to watch for skin irritations, injuries, infections, and other skin changes. The American Diabetes Association provides some how-to guidelines for good skin care.

Moisturize the dry areas

Moisturizer helps fill in gaps and cracks in the skin, temporarily restores elasticity, and can help protect you from infections. Use a moisturizer wherever your skin is dry; don't use moisturizer in damp areas, such as between your toes and inner thighs, or under your arms. Moisturizing ingredients include glycerin, petrolatum, lanolin, wheat germ oil, jojoba oil, mineral oil, borage oil, argan oil, and safflower and pomegranate seed oils. Be sure to ask your doctor or certified diabetes educator for a recommendation on which moisturizer is best for you.

Dry the moist areas

Having diabetes puts you at a higher than average risk for fungal skin infections, especially in chronically moist areas. Use a powder, such as talcum powder, in places where skin touches skin, such as between your toes, under your arms, and between your upper thighs. If you’re uncertain what to use, your doctor can direct you toward good quality products to try.

Wash wisely

Too much time spent in hot water can strip the oil from your skin, so be mindful of your time in the shower. Take short showers using warm—not hot—water. Use a mild soap-free cleanser or a moisturizing body wash, and apply moisturizer to dry areas soon after toweling off.

Use sunscreen

Remember, the winter sun can give you a sunburn—especially if you’re out on the bright ski slopes. Use a sunscreen with SPF 30 or above, and apply at least 30 minutes before going out in the sun—reapply as the package directs.

Treat minor cuts and scrapes

Pay attention to all minor skin injuries and irritations. Wash cuts and scratches right away, and see your doctor if you develop wounds that won’t heal or irritations that appear to be worsening. Remember that the feet are particularly vulnerable in people with diabetes. Always wear comfortable shoes and socks, and check your feet regularly for signs of problems, such as red spots, blisters, or sore areas.

Manage blood sugar levels

Keep your diabetes well managed. People with high glucose levels tend to have dry skin and less ability to fend off harmful bacteria. For example, in one study, people with diabetes who had a hemoglobin A1c (HbA1c) of 8 mmol/mL or higher had significantly more skin disorders than those with a HbA1c of 8 mmol/mL or lower. If you have skin issues, your blood sugar may not be optimally controlled. Talk to your doctor about all of the options for diabetes management, including regular physical activity, a healthy diet, medications, stress management, and insulin.

View your skin as a window to health

People with diabetes who also have nephropathy (kidney damage), neuropathy (nerve damage), and/or retinopathy (eye damage) may experience more bacterial and fungal skin infections, and more cases of “diabetic foot” (ulcerations on the feet), rubeosis faciei (facial redness), pigmented purpuric dermatitis (purple skin splotches), and diabetic dermopathy (reddish, oval or round, slightly indented scaly patches most often appearing on the shins), compared with people with diabetes who don’t have these complications.

So, if you experience frequent skin issues, a total health checkup may be in order. This is always a good idea, as most of the complications of diabetes, including nephropathy, neuropathy, and retinopathy, are managed most effectively when diagnosed early.

(Am J Clin Dermatol 2014;15:65–70)