12 types of diabetes rash and skin problems

Diabetes has become a common condition in the United States. In fact, the Centers for Disease Control and Prevention (CDC) estimate about 1 in 10 Americans have the chronic condition. The good news is that diabetes, characterized by having too much sugar in your blood, can be managed with diet, exercise, and medication in conjunction with guidance from a healthcare provider. But if left unmanaged, diabetes can cause far-reaching complications throughout your body in the heart, nerves, blood vessels, kidneys, and even skin. 

“Diabetes can affect the skin through elevated blood sugar levels, which, over time, can lead to poor circulation and reduced immune function, paving the way for various skin problems,” says Yoram Harth, MD, a board-certified dermatologist and chief medical officer of MDacne. 

Keep reading to learn the different types of skin symptoms you can experience from diabetes and how to treat them.

How does diabetes affect the skin?

Your skin has a lot of functions—sensing pain, temperature, and pressure. That requires many nerves and blood vessels. When diabetes damages these pathways, it can lead to skin problems, especially when blood glucose levels are very high over a long period of time. 

“Diabetes may affect the skin in a number of ways, including dry skin, increased susceptibility to infections, and slow healing,” says  Shawhin Karimi, MD, a board-certified endocrinologist at Houston Methodist Willowbrook Hospital. “It may also lead to skin conditions such as diabetic dermopathy, acanthosis nigricans, or necrobiosis lipoidica.” 

Skin problems can be the first sign of diabetes before someone is diagnosed, or if they are diagnosed, these symptoms may signal a need to adjust treatment for people who know they have the condition. 

“Patients with poorly controlled diabetes as well as those who have other risk factors such as obesity or other underlying health issues are at most risk for diabetes-related skin problems,” Dr. Karimi says. 

12 diabetes skin problems

Although a small cut may not seem important, even minor skin issues can turn into big problems for someone with diabetes. If you have already been diagnosed, it’s important to watch for diabetic rashes and skin problems in order to treat it quickly and potentially notify your endocrinologist, dermatologist, or other healthcare provider. If you haven’t been diagnosed with diabetes, it doesn’t hurt to keep an eye out as well because you may want to speak with your primary care provider about what these issues could mean. Here are the 12 types of skin symptoms from diabetes. 

1. Fungal infections

The fungus most commonly affecting people with diabetes is Candida albicans, which is a harmless bacteria that is found on the skin and in the body. When a person’s immune system is weakened, like in the case of diabetes, Candida albicans can become a skin yeast infection that presents as an itchy rash with tiny red blisters and scaly patches. This type of skin infection affects 11.4% of people with Type 2 diabetes, according to one study. 

Other fungal infections that can occur with diabetes are athlete’s foot, jock itch, ringworm, and vaginal infections. Most can be treated with antifungal medications.

2. Discolored toenails

People with diabetes often experience changes in their toenails due to poor circulation, nerve damage, and an increased risk of fungal infections. The most common symptom of diabetic toenails is discoloration or yellowing of the toenails. Other noticeable changes include thickening of the nail plate, ingrown nails, trumpet or cone-like curvature of the nail, infection of the nail plate, redness, swelling, and tenderness along the nail fold. It is important to regularly check your toenails if you have diabetes and inform your healthcare provider of new symptoms. 

3. Dry, itchy skin

“Diabetic xerosis is dry and itchy skin that is exacerbated by dehydration, neuropathy, or poor blood circulation,” Dr. Karimi says. “It can lead to dry and flaky skin that becomes itchy and uncomfortable.” Treatment involves regular moisturizing, staying hydrated, and maintaining good blood sugar control. 

4. Dark, velvety patches

Acanthosis nigricans is characterized by dark, thickened, and velvety patches of skin in folds like the neck, armpits, groin, and elbows that can be itchy and produce odor. The patches may look flat or slightly raised in different sizes and shapes. People with diabetes are at higher risk of developing acanthosis nigricans, as are those who are obese. 

The condition can be treated with creams, medications, or even laser therapy. Your diabetes provider may refer you to a dermatologist for treatment options.

5. Shin spots

Shin spots, or diabetic dermopathy, cause light brown, dark brown, or reddish spots on the lower leg or shins. Due to their size and color, they are sometimes confused for age spots. Although the cause is unknown, research suggests it stems from a dysfunction of the small blood vessels from chronic high blood sugar levels. It’s common in older people who have had diabetes for 10 to 20 years. 

Shin spots do not cause pain or itching, but they can take a long time to heal because of reduced blood flow, nutrients, and oxygen to the area. There’s no treatment for the issue, but Dr. Karimi recommends keeping the skin clean and moisturized and using sun protection when outdoors.

6. Foot ulcers 

People with diabetes have a 25% risk of developing foot ulcers, which are open sores on the feet. Common on the bottom and sides of the foot and tips of the toes, diabetic foot ulcers are caused by high blood sugar levels, nerve damage (diabetic neuropathy), and inadequate blood circulation. Combined, these conditions make it hard to even notice injuries such as blisters, calluses, or sores. This is a problem because these injuries can worsen without treatment and become ulcers. 

“Patients first need to be evaluated for infection, blood circulation, and nerve function,” Dr. Karimi says. “Treatment includes wound care, pressure relief, and maintenance of good blood sugar control.” 

Foot ulcers can be recurring and take a long time to heal because of impaired circulation; they also can easily become infected, which may lead to tissue death and possible need for amputation. If you develop foot ulcers, regular foot exams, properly fitted shoes, and blood sugar control are essential. 

7. Skin infections

People with diabetes may experience a number bacterial skin infections, including:

• Styes, which occur when Staphylococcus aureus bacteria infect the oil glands found in the eyelids, which then leads to a red, swollen, and painful lump. It is usually filled with pus, and if untreated, it could cause infection in other parts of the eye.
• Boils and carbuncles, which are also caused by Staphylococcus aureus. They are deep skin infections characterized by pus-filled, painful, red, swollen bumps. This condition may affect any area in the body, but it’s most common in the face, neck, armpits, buttocks, and thighs.
• Folliculitis, which can be caused by either bacteria or fungi. It is an infection of the hair follicles and looks like tiny red or white lesions that are often itchy or painful.

8. Stiff skin

Digital sclerosis, also known as diabetic cheiroarthropathy or diabetic stiff skin, causes thickening and tightening of the skin at the joints of the fingers, toes, and hands. The affected areas become stiff and difficult to move while the skin looks waxy, thick, shiny, or yellow. Eventually diabetic stiff skin can result in Dupuytren contracture, a condition that causes your fingers to bend toward your palm. 

Digital sclerosis has no known cure, but symptoms can be managed. “Treatment includes effective blood sugar control, use of moisturizers, topical steroids, and, in certain instances, ultraviolet (UV) therapy may be considered,” Dr. Karimi explains.

9. Impetigo

Although a common (and contagious) skin infection in children, impetigo may also occur in people with weakened immune systems such as seen in diabetes. Impetigo is caused by bacteria, and it can occur in two forms, non-bullous impetigo and bullous impetigo. Non-bullous impetigo is characterized by reddish sores usually around the nose and mouth or other areas of the face and the limbs. Non-bullous impetigo is not painful, but it is itchy. When the sores burst, they leave behind honey-colored crusts on the affected skin. Bullous impetigo is characterized by painful fluid-filled blisters usually on the waist, neck, arms, and legs. Impetigo usually heals on its own within two to three weeks.

10. Small reddish-yellow bumps

Although not a direct symptom of diabetes, eruptive xanthomatosis is a rare skin condition that affects people with high triglycerides, which are common among people with diabetes. The problem starts as tiny bumps on the buttocks, shoulders, arms, thighs, and legs. These bumps are itchy and tender, with colors ranging from yellow, orange-yellow, red-yellow, to red. It is best treated by lowering blood sugar and triglyceride levels.

11. Yellow, reddish, or brown patches

Necrobiosis lipoidica is a rare condition linked to Type 1 diabetes that presents as yellow, reddish, or brown patches on the skin. In the initial stage, it looks like pimple-like bumps, but over time, it forms patches of swollen, hard skin and can lead to skin ulcers. It is commonly seen in the shin; however, it also affects the face, scalp, trunk, arm, and hands. 

This condition is more common in women and occurs because of issues with collagen breakdown, which causes the blood vessels to thicken and fat to deposit in them. There is no known cure, but a dermatologist may recommend topical steroids for managing patches.  

12. Blisters

Fluid-filled blisters that develop on the legs, feet, hands, and arms are a rare complication of diabetes known as bullosis diabeticorum. More common in men, these blisters are different from typical blisters because they are large and painless due to nerve damage in the area. 

This skin condition may appear suddenly and go away on its own after a few weeks. 

If you develop diabetic blisters, avoid breaking the skin in order to reduce the risk of bacterial infection. Even though these blisters may appear suddenly and go away on their own after a few weeks, they can be a sign of poor blood sugar control, peripheral neuropathy, and other vascular issues—so it’s important to speak with your healthcare provider. Depending on the severity, they may prescribe an over-the-counter topical antibiotic cream. 

How to care for your skin if you have diabetes

In order to prevent and treat many of these skin issues, it’s important to maintain a skincare routine. The American Academy of Dermatology Association recommends the following tips for individuals with diabetes:

1. Keep skin moisturized using cream, ointment, or lotion—especially after bathing or swimming and anytime your body feels dry. 
2. Shower using warm or cool water as hot water can make the skin dry and tight.
3. Use a mild soap or cleanser, and avoid deodorant soaps or strong body washes.
4. Dry the folds of skin (the skin between your fingers and toes, armpits, and areas where the skin touches) thoroughly after bathing or swimming to prevent trapped moisture from leading to infections.
5. Treat all wounds or cuts immediately and work with a dermatologist for all slow-healing wounds. 
6. Keep fingernails and toenails clean and short.
7. Examine skin and feet on a daily basis to check for rashes, sores, calluses, or other issues. Treat promptly as needed.
8. Contact a healthcare provider for any concerning symptoms, such as swollen, discolored, painful, or tender skin, fluid-filled wounds, honey-colored crusts, build-up under toenails, or thickening nails.

When to see a dermatologist

Generally, the skin issues associated with diabetes are warning signs that your condition is poorly controlled. If you have been diagnosed with diabetes and notice symptoms of any of the skin issues outlined above, it’s a good idea to reach out to a dermatologist for professional care. 

“Consult a dermatologist if you have persistent or worsening skin conditions, unexplained rashes or infections, or if any skin condition is not responding to over-the-counter treatments,” Dr. Harth says. “A dermatologist can provide specialized care and may work alongside other healthcare providers to manage skin issues related to diabetes.” 

Early detection and prompt treatment will reduce the risk of more severe complications.