OVERVIEW

What is diabetic dermatopathy?

The skin is one of the body's organs, often referred to as the body's outer garment. Everyone has experienced skin lesions to some extent at some point in their lives.

Diabetes is not just about blood sugar—it can cause damage to multiple parts of the body. After developing diabetes, the skin, like other tissues and organs, becomes one of the affected areas and is one of the most common complications in diabetic patients.

The incidence of skin lesions in diabetic patients is three times higher than in healthy individuals. These skin disorders caused by diabetes are referred to as diabetic dermatopathy.

Diabetic dermatopathy includes secondary damage caused by various infections, microvascular complications, and neuropathy. The skin manifestations vary, and some lesions result from multiple factors, leading to severe complications or even life-threatening conditions.

Is diabetic dermatopathy common?

Diabetic skin lesions are not uncommon, affecting approximately 20–50% of diabetic patients, who may develop one or several types of skin disorders.

Diabetic dermatopathy encompasses a wide variety of conditions with diverse manifestations. Some lesions occur exclusively in diabetic patients, while others, though also seen in non-diabetic individuals, are closely related to the progression of diabetes.

Therefore, early recognition of diabetic skin lesions can help in the timely diagnosis of diabetes and provide insights into blood sugar control, playing a crucial role in diabetes prevention and management.

What are the types of diabetic dermatopathy?

Diabetic skin lesions can be categorized into five types based on their causes:

• Vascular-related skin lesions
• Metabolic disorder-related skin lesions
• Neuropathy-related skin lesions
• Infectious skin lesions
• Drug-related skin lesions

SYMPTOMS

What are the common manifestations of vascular lesions in diabetic dermatopathy?

Vascular skin lesions can be divided into many types, with different manifestations:

• Necrobiosis lipoidica: Rare, mainly occurs in women aged 20–50. It presents as symmetrical, oval, pale-yellow plaques on both lower limbs with central atrophy. Usually painless and non-itchy, but ulcers may cause pain. Some patients experience reduced or lost sensation in the affected area.
• Acanthosis nigricans: Relatively common, mostly seen in children. It manifests as symmetrical, wart-like, velvety, hyperkeratotic patches with hyperpigmentation, often appearing in areas like the armpits and neck.
• Diabetic dermopathy (shin spots): A characteristic feature of diabetes, occurring in 30%–60% of cases, mostly in elderly male patients. Lesions appear as round or oval erythema or purpura with raised edges and slightly depressed centers, usually painless and non-itchy. They commonly occur on the front of the lower legs but may also appear on the thighs or forearms, bilaterally but asymmetrically.
• Diabetic bullae: Rare, mainly seen in long-term diabetic patients. Lesions present as sudden large blisters (1.5–10 cm in diameter), painless and non-itchy. If uninfected, they heal spontaneously in 2–6 weeks, often appearing on the extremities, such as toes.
• Diabetic rubeosis (facial redness): Less common, mostly seen in middle-aged or older male patients with mild diabetes and hypertension. It manifests as skin redness, particularly on the cheeks, jaw, and chin.
• Diabetic gangrene: Rare, usually occurs in severe, poorly controlled diabetic patients with neuropathy. It presents as ischemic necrosis of the extremities, most commonly in the feet.

What are the common manifestations of metabolic disorder-related skin lesions in diabetic dermatopathy?

Metabolic disorder-related skin lesions can be divided into many types, with different manifestations:

• Diabetic scleroderma: Rare, mostly seen in long-term, severe diabetic patients. Lesions appear as light red or pale edema with thickened, shiny tissue and no pitting. They are often limited to the neck, shoulders, and upper back, causing facial swelling, thickened neck, and restricted head movement.
• Eruptive xanthoma: Rare, mainly occurs in young male patients with poorly controlled diabetes and hypertriglyceridemia. Lesions appear as clustered, 0.5 cm-sized, yellow-red nodules or papules with a hard texture and red halos, commonly on the knees, elbows, and arms, often accompanied by itching or tenderness.
• Xanthelasma: Less common, mostly seen in middle-aged and elderly individuals. Lesions are soft, yellow cholesterol-filled plaques, usually on the inner eyelids.
• Carotenemia: Uncommon. The skin appears orange-yellow, often on the nasolabial folds, nasal margins, forehead, palms, soles, elbows, and knees.
• Eczema and dermatitis: Relatively common. Includes acute eczema, seborrheic dermatitis, contact dermatitis, and solar dermatitis. Sometimes, hemorrhagic tendencies lead to purpuric lichenoid dermatitis, often occurring in friction-prone areas (e.g., genitals) and sebum-rich regions.
• Pruritus (itching): Common. Presents as generalized or localized itching, with genital itching being frequent.

What are the common manifestations of neuropathic skin lesions in diabetic dermatopathy?

The main condition is diabetic anhidrosis (reduced sweating) or sweating abnormalities, which are relatively common. Anhidrosis may involve generalized sweating reduction or only affect the lower body. Sweating abnormalities may accompany excessive sweating in the upper body, especially the face.

What are the common manifestations of infectious skin lesions in diabetic dermatopathy?

Manifestations vary depending on the pathogen:

• Fungal infections: Often occur under the breasts, armpits, groin, labia, vagina, scrotum, glans, nail folds, finger webs, and mouth corners, classified as tinea corporis, tinea pedis, or onychomycosis based on location.
• Bacterial infections: Common forms include boils, carbuncles, abscesses, and cellulitis.
• Viral infections: The most common type is herpes zoster (shingles).

What are the common manifestations of drug-related skin lesions in diabetic dermatopathy?

Primarily allergic reactions to medications, such as insulin injection site lipoatrophy, lipohypertrophy, photosensitivity, urticaria, erythema multiforme, pruritus, and drug eruptions.

What are the severe consequences of diabetic dermatopathy?

If left untreated, some diabetic skin lesions may worsen, potentially leading to malignancy, secondary infections, or aggravated infections, resulting in sepsis, skin necrosis, amputation, or even life-threatening conditions.

CAUSES

What are the common causes of diabetic dermatopathy?

Common causes include vascular lesions, metabolic disorders, neuropathy, infections, drug allergies, etc.:

• Many diabetic patients suffer from peripheral neuropathy, leading to reduced or lost skin sensation, which diminishes the skin's self-protective function. This makes them more susceptible to external injuries and subsequent infections.
• Diabetes-related microvascular disorders and autonomic neuropathy disrupt the skin's "nutritional" supply.
• Metabolic disorders associated with diabetes can trigger corresponding skin lesions, often visible on the face.
• Certain medications used in diabetes treatment may also affect the skin.
  Thus, the skin of diabetic patients faces challenges both internally and externally, making it more vulnerable to damage.

Who is more prone to diabetic dermatopathy?

The older the diabetic patient and the higher the blood sugar level, the more likely they are to develop skin lesions.

DIAGNOSIS

How is diabetic dermopathy diagnosed?

When diagnosing diabetic dermopathy, doctors first confirm the diagnosis of diabetes. Then, they identify the specific type of skin condition based on the characteristics of the skin lesions. If necessary, they may search for evidence of bacterial or fungal infections, perform a skin biopsy, or conduct tests such as angiography, X-rays, CT scans, or MRI to determine the exact type of diabetic skin disease.

TREATMENT

Which department should I visit for diabetic skin disease?

Endocrinology and Dermatology.

Can diabetic skin disease heal on its own?

Diabetic skin disease generally does not heal on its own. Early detection and treatment are necessary to prevent worsening of skin lesions due to delayed treatment, which may lead to severe complications or even life-threatening conditions.

How is diabetic skin disease treated?

Comprehensive management of diabetes and related metabolic disorders is essential, ensuring long-term, sustained, and stable control of blood sugar, blood lipids, blood pressure, etc. This forms the foundation for preventing and treating diabetic skin diseases.

• For infectious skin diseases, anti-infective treatment targeting the pathogen may be administered;
• For lesions with significant itching, avoid scratching or rubbing, and antihistamine drugs may be prescribed;
• For blisters, larger ones can be drained with a sterile syringe after disinfection, followed by local bandaging and regular dressing changes to prevent infection;
• For certain skin lesions, such as eczema, glucocorticoid therapy may be considered as appropriate.

Is hospitalization required for diabetic skin disease?

In most cases, hospitalization is not necessary. However, if the condition is severe—such as with serious infections, extensive skin lesions, significant blood sugar fluctuations, systemic symptoms (e.g., fever), or acute diabetic complications (e.g., diabetic ketoacidosis)—hospitalization may be required.

DIET & LIFESTYLE

What should patients with diabetic dermatopathy pay attention to in their diet?

Dietary precautions are the same as for diabetes.

What should patients with diabetic dermatopathy pay attention to in daily life?

• In daily life, special attention should be paid to protecting hands and feet from trauma. If there is trauma, even very small wounds should seek medical treatment promptly.
• If there are abnormal foot changes such as calluses, corns, or athlete's foot, seek medical attention promptly. To avoid foot skin damage and infections, do not attempt to remove corns by yourself.
• Seek medical attention immediately if you notice abnormal skin changes such as redness, swelling, injuries, or blisters.

PREVENTION

Can Diabetic Dermopathy Be Prevented? How to Prevent It?

Most diabetic dermopathy cases can be prevented. Comprehensive management of diabetes and related metabolic disorders, ensuring long-term, sustained, and stable control of blood sugar, lipids, blood pressure, etc., is the foundation for preventing and treating diabetic skin conditions.

• Develop a habit of checking your skin regularly in the morning and evening, focusing on the heels, toes, and soles for any abnormal changes.
• Wear properly fitted, soft shoes, cushioned insoles, and cotton socks.
• Maintain foot hygiene by washing feet daily with warm water and gently drying them afterward.
• Keep feet warm in winter, but avoid soaking them in excessively hot water or exposing them to direct heat, as this may cause burns.
• To reduce fungal infections, wear well-fitting shoes and socks made of soft, breathable materials.
• Opt for flat shoes and regularly inspect them for debris or damage.
• Trim toenails after washing and drying feet. Cut them straight across to avoid ingrown nails or infections, and apply vegetable oil to hardened areas if necessary before trimming.
• Apply moisturizer or vegetable oil to massage and hydrate dry skin on the feet.