An estimated 29.1 million people — almost 10% of the total US population — have diabetes mellitus (DM). And nearly 80% of all diabetic patients have skin disorders, many of which are present even before the diagnosis of DM is made.
Patients often complain of apparently isolated cutaneous symptoms ranging from mild to life-threatening, which may actually point to a prediabetic state or undiagnosed fulminant diabetes. In patients who are already diagnosed with DM, skin manifestations suggest lack of therapeutic adherence or suboptimal response to current therapy.
Which Skin Disorders Are Markers For Undetected Diabetes?
Attention to skin disorders in the setting of diabetes can be clinically very useful.[1,2] Certain types of skin disorders are markers for undetected diabetes and should prompt glucose metabolism testing for diabetes, including:
- Necrobiosis lipoidica — a necrotizing granulomatous skin disorder that can cause permanent scarring and disability
- Generalized granuloma annulare
- Diabetic bullae
- Scleroderma diabeticorum
- Acanthosis nigricans
- Eruptive xanthomatosis
- Acquired perforating dermatoses
- Diabetic dermopathy
Other, less severe cutaneous symptoms such as yellowed skin and nails, thickened skin, and generalized pruritus are more commonly seen in patients with diabetes than in the general population. Skin tags — a relatively benign and common condition — may suggest a lack of glycemic control, as greater numbers of skin tags have been reported in people with diabetes.
People with rubeosis faciei have a perpetually flushed look to the skin around the face and neck, which is a common sign of diabetes.
Erythema of the palms may suggest diabetes, but are also signs of poisoning or drug reactions or cancers of the central nervous system (CNS), and may resemble erythematic features of lupus. Nail bed erythema suggests a compression to microvessels that may also involve changes to the cuticles and tenderness of the fingertips.
What Can Healthcare Providers Do?
These skin conditions (as well as pre-existing vitiligo) may all be aggravated by poorly-managed diabetes, while still others such as abscesses, keloids, lipoatrophy and lipohypertophy form in response to diabetes treatment.
The bottom line for NPs and PAs is to add questions about seemingly benign skin conditions to standard evaluations, especially in patients who are older, obese, or who have signs of metabolic disorder.
Last updated on 9/25/19.