The commonest skin manifestation of diabetes mellitus is prolonged (protracted) wound healing time and skin ulcerations. The wound healing in diabetes is prolonged than usual is because of the high blood sugar level and also due to lower cell mediated immunity which makes it difficult for the body to fight organisms that may be present in the wound. Skin manifestations of diabetes, sometimes termed as “diabetic skin spots,” which begins as an erythematous area and evolves into an area of circular hyper pigmentation.
These lesions (diabetic skin spots) result from minor mechanical trauma in the pretibial (in the shin bone area) region and they are more common in elderly men with diabetes. Sometimes bullous diseases known as bullosa diabeticorum (shallow ulcerations or erosions in the pretibial region), are also seen.
Vitiligo also occur more frequency in patients with type 1 diabetes. Acanthosis nigricans which is hyper pigmented velvety plaques seen on the neck, axilla, or extensor surfaces of arms is sometimes a feature of severe insulin resistance and accompanying diabetes (type-1 diabetes). Generalized or localized erythematous plaques on the extremities or trunk and scleredema (areas of skin thickening on the back or neck at the site of previous superficial infections) are more common in the patients with diabetes. Lipoatrophy and lipohypertrophy can occur at insulin injection sites but are unusual with the use of human insulin. Xerosis and pruritus (itching) are common and both of these problems are relieved by skin moisturizers.
A rare skin manifestation of diabetes known as ‘Necrobiosis lipoidica diabeticorum’ is a rare disorder of diabetes generally predominantly affects young women with type 1 diabetes, neuropathy, and retinopathy. ‘Necrobiosis lipoidica diabeticorum’ usually begins in the shin bone area as an erythematous plaque or papules and gradually enlarges, darkened, and develop irregular margins, with atrophic centers and central ulceration. These lesions may be painful.
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