Skin disease

Many skin conditions are unique to the person with diabetes because of the treatment and complications of the disease. The most common and important skin complications include the following:

1 Bruises occur because insulin needles cut blood vessels.

1 Vitiligo (loss of skin pigmentation) is part of the autoimmune aspect of type 1 diabetes and can't be prevented.

1 Necrobiosis lipoidica, which also affects people without diabetes, creates patches of reddish-brown skin on the shins or ankles, and the skin becomes thin and can ulcerate. Females tend to have this condition more often than males. Steroid injections are used to treat this condition, and the areas eventually become depressed and brown.

1 Xanthelasma, which are small, yellow, flat areas called plaques on the eyelids, occur even when cholesterol isn't elevated. Treatment may not be necessary.

1 Alopecia, or loss of hair, occurs in people with type 1 diabetes, but the cause is unknown.

1 Insulin hypertrophy is the accumulation of fatty tissue where insulin is injected. This condition is prevented by changing the injection site (see Chapter 10 for more information on insulin injection).

1 Insulin lipoatrophy is the loss of fat where the insulin is injected.

Although the cause is unknown, this condition is rarely seen now that human insulin has replaced beef and pork insulin in diabetes treatment (see Chapter 10).

1 Dry skin is a consequence of diabetic neuropathy, which leads to a lack of sweating (refer to the earlier section "Disorders of automatic (autonomic) nerves" for more on sweating). Treatment is with skin lubricants.

1 Fungal infections occur under the nails or between the toes. Fungus likes moisture and elevated glucose, so lowering glucose and keeping the toes dry prevents these infections. Medications may cure this problem, but it recurs if glucose and moisture aren't managed.

1 Diabetic thick skin, which is thicker than normal skin, occurs in people who have had diabetes for more than ten years. No treatment exists for this condition.

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