A well-groomed investment banker, Priscilla* loved wearing dresses with attractive necklines. But two years ago she noticed that the skin folds at the nape of her neck were a few shades darker than her overall complexion, and her skin texture there was thicker than usual.

Her hair stylist, too, noticed it when Priscilla went for her regular haircut. ‘But she told me that it could be a skin allergy following a DIY hair colour touch-up that I did at home,’ says the 45-year-old Dubai resident.

Although she wasn’t too happy about the skin problem, which prevented her from wearing many of her favourite dresses, her hectic job and life as a mother of two young kids forced her to push the problem to the back of her mind.

It was only long after, during a mandatory health screening for a life insurance policy, that Priscilla discovered that her blood sugar levels were elevated. More tests revealed that she was a type 2 diabetic. The darkened skin on the neck was a symptom. ‘I wish I hadn’t ignored that first symptom and had it checked out by an expert,’ she says now. ‘I could have brought my condition under control earlier and prevented the problem from worsening.’

Priscilla fell among one of 193 million people globally – close to half of all adults – who are unaware that they have the disease, according to an estimate by The International Diabetes Federation (IDF) .

What’s more, 95 per cent of these cases are type 2 diabetes; the rest few, Type 1.

Living with diabetes and its related issues is no easy task, and this is amplified by all the skin problems diabetics face. ‘The most commonly visible skin problems linked to diabetes are seen in the lower legs and arms,’ says Dr Satyendra Kumar Multani, consultant endocrinologist and diabetologist, Prime Healthcare Group, Dubai. ‘Most type 2 diabetics commonly suffer from dry and itchy skin conditions in the body extremities, such as the lower legs, feet, arms and hands. Excessive dry skin in legs and feet, extremely cracked feet, calluses and corns, itchy and scaly skin… these conditions are caused by untreated dryness and reduced sensation as a result of neuropathy or damaged nerves.’

Skin dryness is more severe when diabetes goes undetected for long periods of time and the blood glucose levels stay uncontrolled for years. ‘Almost 40-50 per cent of patients develop excessively dry skin, especially so in the cases of patients who are detected five-10 years after they have developed the condition,’ says Dr Multani. ‘Sometimes severe neuropathy can also further damage the sweat glands leading to dry and dehydrated skin as well.’

Another skin condition diabetics face is the presence of small yellowish fat deposits on the skin – a result of a sluggish pancreas. ‘Although these can also be seen in non-diabetics on the upper eyelids, it’s not usually a cause for worry, unless it’s very severe and seen below the lower eyelids,’ says Dr Ramachandran Rajagopal, specialist dermatologist at Thumbay Hospital, Dubai.

High blood sugar in the body over long periods of time can also lead to other skin problems. ‘One such issue is acanthosis nigricans (AN) – the darkening and thickening of skin creases and small eruptions in the skinfold areas such as on the nape of the neck and armpits,’ says Dr Ramachandran.

‘A common skin issue, it is seen in both type 1 and 2 diabetes and especially in overweight patients. AN is an indicator of uncontrolled blood sugar levels and once that’s brought under control, the problem can be treated. In some patients, weight loss can also help to reduce the appearance of the thickened skin folds to a large extent.’

Then there’s shin spots or diabetic dermopathy, caused by hindered blood circulation. As the name suggests, it causes round and dimpled painless lesions on the shins.

While these issues are predominantly common among adults, among children having type 1 diabetes we usually see vitiligo, says Dr Hanaa Zidan, paediatric endocrinologist (diabetes) at American Hospital, Dubai. Vitiligo is an autoimmune skin disease where the patient can get unsightly white discolouration patches on the skin of the face or the rest of the body.

Says Dr Zidan: ‘Though medical science has not been able to establish a direct link between type 1 diabetes and vitiligo, the fact that both of them are autoimmune diseases means the two are generally seen to coexist with each other.’

Experts agree that it is very important that the skin condition be treated in the initial stages. ‘If ignored, some of these skin conditions can deteriorate into potentially serious and irreversible skin complications of diabetes,’ says Dr Zidan.

Prevention and Treatment

Diabetics should follow a more elaborate skincare routine than a non-diabetic person.

First, diabetics must know their skin type and moisturise according to it. ‘Some people need more water-based products; others may need more oil-based products,’ says Dr Multani.

Patients need to check with a dermatologist regarding their skin type and choose an appropriate moisturiser. ‘For some patients, itching can sometimes disturb their sleep schedule too. So we tell such patients, and in fact everyone, 
to moisturise their skin at night so it doesn’t feel dry or itchy during sleep.’

Diabetics with neuropathy should be careful about their feet. It is especially important to treat cracked heels and calluses promptly.

Dr Multani advises his patients to opt for special diabetic socks available in the market. These come without the tight elastic bands that can restrict blood flow.

Another factor that affects diabetes skincare management is choice of shoes. Dr Multani advises having two pairs of shoes that are comfortable so they can be rotated and used. Go for comfortable models, ones that are broader in the front and offer more toe room. Pointy shoes may be trendy, but they can cause chronic feet problems for diabetics. Also, regularly check the inside of shoes for wear and tear. If you notice any excess wear and tear discard the shoe as it can affect pressure distribution and lead to callosities. And avoid walking barefoot as that causes heel cracks, and in cases of neuropathy the patient may not even realise that there has been some trauma to the feet.

Buy your shoes in the evening as during that time your feet are tired and slightly swollen, so the size you choose will be perfect for your feet.

Diabetics needs to take special care when opting for manicures and pedicures. Look for trained and specialist podiatrists when booking an appointment.

‘We always ask our clients if they have diabetes or any health issue and if they are diabetic, we take extra care,’ says Jeremy Jeune, podiatrist at Bastien Gonzalez, Dubai, the French foot care/podiatry studio at the One & Only Royal Mirage.

‘For instance, we do not use any foot file/stone, as it will irritate the skin and can damage it.’ Nail cuticles also require more specialised care in such cases. ‘We ensure not to push them as the cuticles are the waterproof barrier for the nail against bacteria and fungus.’

Ayurvedic management

Dr Asha Jones, Ayurvedic practitioner at Dubai Herbal Treatment Centre, recommends some dietary remedies for controlling diabetes so that the skin problems can be prevented right at the onset.

‘According to Ayurveda, wheat, barley, old brown rice, green gram, horse gram, bitter gourd, turmeric, ginger, garlic, pepper, drumstick vegetable, Indian gooseberry… they are all advised commonly in diabetic diets,’ she says.

‘Foods like rhizomes or roots, oil, ghee, jaggery, alcohol, carbohydrate-rich foods, yogurt and new grains are completely restricted for diabetic patients.’

For fungal and other skin infections, Dr Jones recommends herbs like neem (Azadirachta indica) and turmeric (Curcuma longa) be used topically. These herbs can be boiled with water and used to clean the affected area. After drying the skin, one can apply a mixture of turmeric powder with neem oil.

For dry skin and cracked heels and feet, Ayurvedic traditional oil preparations like Nalpamaradi Kerathailam, Eladi Kerathailam, and Jataydi thailam can be used.

Take heart – health experts say, given timely attention and correct medical supervision, most of the diabetes-related complications in the body are controllable, and the same goes for these skin problems caused by the condition.

*Name changed