Understanding and Managing Dermatologic Manifestations of Diabetes

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Although routine skin care is an integral component of health care for everyone, it is particularly vital for patients with diabetes, especially those with undiagnosed or poorly controlled diabetes, who are at greater risk of dermatological issues, including bacterial and fungal infections, poor wound healing, changes in skin appearance, and dry, irritated, and itchy skin.¹

The American Diabetes Association (ADA) notes that skin issues are sometimes an early indication of diabetes, and conditions such as diabetic dermopathy (characterized by brown or reddish shin spots), acanthosis nigricans, or slow-healing wounds can signal undiagnosed diabetes or poorly managed blood glucose levels.^1,2 The ADA also notes that these clinical manifestations typically occur due to undiagnosed diabetes, elevated glucose levels, poor circulation, or neuropathy, highlighting the critical role of routine screenings and early detection.^1,2

According to a review published in Diabetology & Metabolic Syndrome, an estimated 97% of patients with diabetes will experience at least 1 skin condition at some point, with tinea pedis (35%), candidiasis of the skin/nail (26%), pigmentation disorders (22%), xerosis (22%), and tinea unguium (22%) as the most commonly reported dermatological diagnoses among patients with diabetes.³ The ADA indicates that lack of proper diabetic skin care, including foot care, can lead to numerous complications, including infections, foot ulcers, and amputation in the most serious cases.¹ Other commonly reported skin issues include dermatitis, skin tags, and warts.

During counseling, clinicians can advise patients that the essential components of diabetic skin care generally focus on preventive measures involving skin, foot, and nail care. Additionally, clinicians should emphasize the significance of tight glycemic control, following an appropriate skin care routine, and seeking medical care if unsure about a skin issue to reduce or avert complications such as infections.

Skin Care Tips

Below are recommendations from the ADA and American Academy of Dermatology (AAD)^4,5:

• Maintain glycemic control: Proper diabetes management is essential to prevent complications such as xerosis and increased susceptibility to bacterial and fungal infections, which elevate the risk of cutaneous and systemic infections.
• Routine hygiene practices: Advise patients to keep skin clean and dry, avoid very hot showers or baths, use nonirritating moisturizing soaps, and apply lotion to maintain skin hydration. Clinicians can also caution against applying lotion or creams between the toes to avoid developing a fungal infection. The ADA and AAD recommend moisturizers that contain ceramides. Patients should treat dry, cracked heels to prevent serious infections and other issues, such as nonhealing sores.
• Manage xerosis: Patients should moisturize their skin daily, particularly during cold and windy conditions that can exacerbate dry skin. They should also avoid scratching itchy skin.
• Wound care protocol: Advise patients to clean minor wounds with soap and water, apply sterile gauze to cover wounds, and use topical antibiotics only upon health care provider approval. Encourage immediate evaluation for major wounds, burns, infections, or other skin issues, especially those exhibiting signs of infection.
• Conduct routine foot inspections: Patients should check daily for sores, blisters, abrasions, dry skin, changes in skin color or texture, and cuts. Encourage patients to keep toenails short and seek immediate care for a skin or nail infection. Obtain medical care for calluses on the feet.

Several nonprescription topical dermatological products, including lotions, creams, and cleansers, are marketed for routine skin care. These products are formulated to meet the needs of patients with diabetes. Some of these products contain urea, antioxidants, and ceramides to restore and maintain the integrity of the skin barrier.

TABLE: Courtesy of Pharmacy Times

The Table highlights examples of products marketed for diabetic skin care. The ADA and AAD recommend that skin care products for diabetes have the following characteristics^1,2,5,6:

• Use mild, fragrance-free, and hypoallergenic cleansers that contain ceramides to prevent skin irritation and xerosis.
• Use moisturizers that are rapidly absorbed, hypoallergenic, fragrance-free, nonirritating, and contain ceramides to maintain and restore the skin barrier.
• Use a broad-spectrum sunscreen with an SPF of at least 30 and wear protective clothing such as wide-brimmed hats and long-sleeved shirts outdoors, especially in direct sun during peak hours between 10 am and 4 pm. Stay in the shade whenever possible and reapply sunscreen every 2 hours, or more frequently if swimming or sweating.

When discussing skin care products, clinicians can emphasize the importance of adhering to treatment, maintaining strict glycemic control, and continuing routine health care as well as the value of daily skin care and skin inspections.

Conclusion

Using a combination of preventive skin care measures and appropriate skin care products can help patients with diabetes maintain healthy skin. The availability of dermatologist-recommended products for individuals with diabetes highlights the importance of keeping skin healthy and well moisturized to prevent complications such as xerosis, irritation, infections, open sores, and slow-healing wounds. Daily foot inspections and prompt treatment of minor wounds are also crucial to preventing serious complications, including infections.

Clinicians can remind patients that prioritizing routine skin care in their daily routines is a critical step in diabetes management, along with adhering to recommended diabetes treatment plans and routine follow-up to enhance overall health and well-being.

Yvette C. Terrie, BSPharm, RPh, is a consulting pharmacist and medical writer in Haymarket, Virginia.

References

1. Skin care and infections. American Diabetes Association. Accessed April 7, 2025. https://professional.diabetes.org/sites/dpro/files/2023-12/sci-advisor_2018_skin_care_and_infections_v3.pdf
2. Ludmann P. Diabetes: 10 warning signs that can appear on your skin. American Academy of Dermatology Association. Updated May 22, 2024. Accessed April 7, 2025. https://www.aad.org/public/diseases/a-z/diabetes-warning-signs
3. de Macedo GM, Nunes S, Barreto T. Skin disorders in diabetes mellitus: an epidemiology and physiopathology review. Diabetol Metab Syndr.2016;8(1):63. doi:10.1186/s13098-016-0176-y
4. Diabetes and Skin Complications. American Diabetes Association. Accessed April 7, 2025. https://diabetes.org/about-diabetes/complications/skin-complications
5. Skin care basics. American Academy of Dermatology Association. Accessed April 7, 2025. https://www.aad.org/public/everyday-care/skin-care-basics
6. Ludmann P. Dermatologist-recommended skin care for people with diabetes. American Academy of Dermatology Association. Updated January 4, 2024. Accessed April 7, 2025. https://www.aad.org/public/diseases/a-z/diabetes-skin-care

[This article was originally published by our sister publication, Pharmacy Times.]