The tell-tale signs of the skin

Dr Rakesh Newaj shares the tell-tale signs of the skin that can be indicative of underlying diabetes.

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Diabetes, a multi-faceted condition marked by the body’s inability to regulate blood glucose levels effectively, can exert profound effects on various organs.

Most of the time, it’s discovered fairly late, when other organ complications, prompts the medical practitioner to do a blood glucose test. At this stage, some of the damage caused by unregulated blood glucose is usually irreversible. Fortunately, the skin, serving as a visible interface with the external environment, often reflects internal metabolic disturbances, offering valuable insights for diagnosis and management.

Acanthosis nigricans

One prominent cutaneous manifestation indicative of insulin resistance and impending diabetes is acanthosis nigricans. This condition manifests as velvety, hyperpigmented patches of skin, typically observed in areas such as the neck, axillae, and facial regions.

Despite rigorous hygiene practices, the distinct texture persists, prompting individuals to seek evaluation for underlying insulin resistance and diabetes. Treatment strategies encompass a holistic approach, including meticulous blood glucose control, regular physical activity, weight management interventions, and, in some cases, adjunctive therapies like chemical peels to address cosmetic concerns.

Dry skin

Individuals grappling with poorly-controlled diabetes often contend with troublesome dermatological issues, such as dry skin, particularly prevalent on the shins, accompanied by intense itching. This tends to be very persistent with bouts of scratching that leads to injuries on the skin.

Effective management entails meticulous blood glucose regulation alongside targeted interventions, such as the application of specialised moisturising creams, to alleviate discomfort and prevent complications. Sometimes the use of antihistamines and steroid creams can be very helpful in easing symptoms.

Skin tags

Moreover, the presence of multiple skin tags in regions like the neck, face, axillae, or groin may signal an underlying association with diabetes, often also linked to obesity. These tags can appear over a short period of time and can be very unsightly.

Treatment modalities typically involve the removal of these skin tags through cautery procedures, aiming to alleviate discomfort or improve the cosmetic look.

Skin infections

Diabetic individuals, owing to compromised immunity and metabolic dysregulation, frequently encounter recurrent skin infections. Bacterial infections commonly present as multiple sores scattered across the body, necessitating prompt medical attention and targeted antimicrobial therapy.

Conversely, rashes in skin folds should raise suspicion of fungal infections, such as candida. Another very common fungus infection in people with diabetes is called pityriasis versicolor. It appears as hypo or hyperpigmented patches mainly on the back and chest regions.

Addressing these infections may involve antifungal medications and meticulous hygiene practices to prevent recurrence. Additionally, diabetic individuals may contend with recurring vaginal yeast infections and oral thrush, warranting comprehensive management strategies tailored to individual needs.

Delayed wound healing

Prolonged hyperglycaemia can culminate in systemic complications, including impaired circulation and nerve damage, precipitating delayed wound healing and the development of diabetic ulcers.

In severe cases, chronic poor glycaemic control may precipitate toe gangrene, necessitating aggressive interventions, including amputations, to forestall further complications.

Diabetic dermopathy

Diabetic dermopathy is characterised by brownish skin discoloration on the shin. This type of skin lesion is fairly common and starts as pale macules which become darker in colour with time.

Many patients are unaware of its implications and try to ignore it at first till it becomes a cosmetic disturbance. The brown patches pose a therapeutic challenge to doctors due to their stubborn nature.

Diabetic blister

Sometimes patients present with a single blister on the lower leg, without a history of trauma. The blister appears overnight and can be fairly big. This is called a diabetic blister and warrants a full investigation to exclude the disease.

Necrobiosis lipoidica

Necrobiosis lipoidica can be considered as one of the cutaneous markers of diabetes. It presents as yellow atrophic patches, most often on the shins. Sometimes a red-brown rim may indicate activity at the border. Ulceration may also occur and is very slow to heal. There can be reduced sensation to fine touch in the affected area. The affected person needs to see a dermatologist to confirm the diagnosis and treat this condition.

Comprehensive management

While various other rare cutaneous signs may serve as harbingers of underlying diabetes, consultation with healthcare professionals is paramount for accurate diagnosis and comprehensive management. By adopting a multi-disciplinary approach encompassing lifestyle modifications, pharmacotherapy, and preventive measures, individuals can mitigate the impact of diabetes on skin health and overall well-being.

Dry skin and fungal infection in a diabetic
Dry skin and fungal infection in a diabetic
Acanthosis nigricans and skin tags
Acanthosis nigricans and skin tags
Diabetic dermopathy
Diabetic dermopathy
Dr Rakesh Newaj is a specialist dermatologist with special interest in skin surgeries. Since qualifying in 2010, he practices in Waterkloof, Benoni, Kempton Park as well as Mauritius. His special interests lie in skin cancers, hidradenitis suppurativa and stem cell and fat grafting.


Dr Rakesh Newaj is a specialist dermatologist with special interest in skin surgeries. Since qualifying in 2010, he practices in Waterkloof, Benoni, Kempton Park as well as Mauritius. His special interests lie in skin cancers, hidradenitis suppurativa and stem cell and fat grafting.


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