Diabetes-Related Skin Problems You Should Know About

1. Diabetic Dermopathy

Diabetic dermopathy, often referred to as “shin spots,” is one of the most common skin conditions linked to diabetes. These small, round or oval patches usually appear on the shins and are characterized by light brown, scaly discolorations. The underlying mechanism involves changes in the small blood vessels due to chronic high blood sugar, which leads to poor circulation and minor skin injuries that do not heal properly. Over time, these areas may become atrophic, making the skin thin and fragile.

For example, a person with diabetes may notice clusters of these painless spots developing on their lower legs, especially after bumping into furniture. While diabetic dermopathy is generally harmless and does not require treatment, it can sometimes be confused with other, more serious conditions. It’s important to monitor these skin changes, as they may indicate underlying vascular complications.

Individuals should seek medical advice if the spots become ulcerated, infected, or if new symptoms such as swelling, redness, or pain develop. For more information, visit the American Academy of Dermatology Association for guidance on diabetes-related skin conditions and when to consult a healthcare professional.

2. Necrobiosis Lipoidica

Necrobiosis lipoidica is a rare but striking inflammatory skin disorder most commonly associated with diabetes, particularly type 1. It presents as well-defined, shiny patches that often start as small, red papules and gradually expand into larger plaques with a yellow-brown center and a red or purple border. These lesions typically develop on the shins but may also appear on the forearms or other areas of the body. Over time, the affected skin may become thin, atrophic, and prone to ulceration, especially if injured.

Unlike diabetic dermopathy, necrobiosis lipoidica lesions are less common and tend to be more severe. They may cause discomfort, tenderness, or even pain, especially if ulcers form. The appearance of necrobiosis lipoidica is distinct from other skin lesions such as bruises or eczema, given its waxy, translucent look and the tendency to develop central thinning. While diabetic dermopathy is purely cosmetic, necrobiosis lipoidica may lead to serious complications if not managed appropriately.

For visual examples and additional information, refer to the DermNet NZ resource on necrobiosis lipoidica. Early recognition and medical intervention are important to prevent progression and secondary infection of these lesions.

3. Acanthosis Nigricans

Acanthosis nigricans is a skin condition characterized by areas of thickened, darkened, and velvety skin, most commonly found in body folds such as the neck, armpits, groin, and sometimes on the knuckles or elbows. This condition is closely linked to insulin resistance, a hallmark of type 2 diabetes and prediabetes. Elevated insulin levels stimulate the growth of skin cells and increase melanin production, leading to the distinct appearance of acanthosis nigricans.

Early signs include subtle darkening and thickening of the skin, which can progress to more pronounced velvety plaques. While acanthosis nigricans itself does not cause discomfort, itching or odor may develop in severe cases. It is important to recognize this skin change as it often precedes the diagnosis of diabetes or signals worsening insulin resistance. Prompt identification allows for timely intervention in metabolic health and diabetes management.

If you notice darkening or thickening of the skin in the areas mentioned above, it is important to consult a healthcare provider for evaluation. This may prompt further investigation into underlying metabolic conditions. For more comprehensive details, visit the American Academy of Dermatology Association’s page on acanthosis nigricans.

4. Diabetic Blisters (Bullosis Diabeticorum)

Diabetic blisters, known medically as bullosis diabeticorum, are a rare but distinctive skin complication of diabetes. These blisters develop spontaneously, without obvious trauma, and typically appear on the hands, feet, legs, or forearms. The blisters are often large, painless, and filled with clear fluid, resembling blisters caused by burns. Unlike burn blisters, however, diabetic blisters usually arise without pain, redness, or warmth in the surrounding skin, making them unique in their presentation.

Bullosis diabeticorum is most common among people with longstanding diabetes and those with neuropathy or poor circulation. The exact cause remains unclear, but it’s believed to result from microvascular changes and increased skin fragility in people with poorly controlled blood sugar. While these blisters usually heal on their own within two to six weeks, they are prone to secondary infection if not properly cared for.

Proper wound care involves keeping the blister clean and dry, avoiding popping or puncturing the blister, and monitoring for signs of infection such as redness, pus, or swelling. If infection is suspected or the blister does not heal, seek medical attention promptly. For further information on diabetic blisters and wound care, visit the Mayo Clinic’s guide to diabetic blisters.

5. Eruptive Xanthomatosis

Eruptive xanthomatosis is a skin condition that presents as sudden outbreaks of small, yellow, firm bumps surrounded by red halos. These distinctive lesions are typically found on the buttocks, thighs, elbows, and the backs of the knees, and they can sometimes be itchy or tender. Eruptive xanthomatosis is closely associated with uncontrolled diabetes and significantly elevated blood triglyceride levels, a type of fat found in the blood.

The condition occurs when extremely high levels of circulating fats leak out of the blood vessels and get deposited in the skin, forming these bumps. People with type 1 or type 2 diabetes who have poor glycemic control are at greater risk, especially if they also have a history of hyperlipidemia. The appearance of eruptive xanthomatosis is a warning sign that lipid levels may be dangerously high, increasing the risk for pancreatitis and cardiovascular disease.

If you notice sudden crops of yellowish bumps on your skin, it is important to consult your healthcare provider promptly for a check of your blood lipid and glucose levels. For more details about this condition and the importance of lipid management in diabetes, visit the Mount Sinai Health Library on xanthomatosis.

6. Digital Sclerosis

Digital sclerosis is a diabetes-related skin problem characterized by the thickening, tightening, and hardening of the skin on the fingers and hands. This condition often begins with a waxy, stiff feeling in the skin, which gradually becomes more pronounced over time. The fingers may look shiny, swollen, and feel firm to the touch. As digital sclerosis progresses, it can significantly restrict the range of motion in the fingers and hands, leading to what is known as limited joint mobility syndrome.

Limited joint mobility is more common in people with long-standing or poorly controlled diabetes, and it can affect daily activities such as writing, buttoning clothes, or gripping objects. In severe cases, the skin changes can extend to the forearms and upper arms. Early intervention is crucial to maintain hand function and prevent permanent stiffness.

To manage digital sclerosis, flexibility and stretching exercises are highly recommended. These exercises help maintain joint mobility, reduce stiffness, and improve hand function. Occupational or physical therapy may be beneficial for developing a tailored exercise plan. For more information about digital sclerosis and recommended flexibility exercises, visit the American Diabetes Association’s resource on skin complications.

7. Disseminated Granuloma Annulare

Disseminated granuloma annulare is a chronic skin condition characterized by the appearance of ring-shaped, reddish or skin-colored bumps that may be slightly raised. Unlike localized granuloma annulare, which affects smaller areas, the disseminated form appears over larger and multiple regions of the body, such as the trunk, arms, and legs. These lesions are usually symmetrical, and although they are painless and non-itchy for most, they can sometimes cause discomfort or mild itching in some individuals.

This skin condition is more frequently observed in people with diabetes, particularly when blood sugar levels are not well controlled. It is considered to have an autoimmune component, drawing parallels with other skin diseases like lupus and vitiligo where the immune system mistakenly attacks the skin. The cause of granuloma annulare remains unclear, but its association with diabetes highlights the importance of metabolic control in managing skin health.

If you notice persistent, ring-shaped reddish bumps that do not resolve, it is advisable to seek a referral to a dermatologist. Specialized assessment is important for accurate diagnosis and to rule out other autoimmune or infectious causes. For more details, see the DermNet NZ resource on granuloma annulare.

8. Bacterial Skin Infections

People with diabetes are at a significantly higher risk for bacterial skin infections due to impaired immune function and elevated blood sugar levels, which create an environment where bacteria can thrive. The most common culprits are Staphylococcus aureus and Streptococcus species, which can lead to a variety of infections including boils, carbuncles, cellulitis, and impetigo. These infections often present as red, swollen, painful areas that may be warm to the touch and sometimes contain pus or develop into abscesses.

Bacterial skin infections can escalate quickly in individuals with diabetes, sometimes spreading rapidly or leading to complications such as deep tissue infections or sepsis. Symptoms to watch for include sudden redness, increased pain, swelling, fever, or red streaks extending from the infected area—all of which require immediate medical attention.

Timely diagnosis and prompt initiation of antibiotic therapy are critical to prevent complications. Infections should never be ignored or self-treated, especially in those with diabetes. Maintaining good blood sugar control and practicing meticulous skin hygiene can help reduce risk. For more on recognizing and treating bacterial skin infections, visit the Centers for Disease Control and Prevention: Diabetes and Skin Problems.

9. Fungal Infections

Fungal infections are a frequent concern for individuals with diabetes, particularly when blood glucose levels are not well controlled. The most common fungal invader is Candida, a type of yeast that causes red, itchy rashes often found in warm, moist body folds such as under the breasts, around the groin, between fingers and toes, and in the corners of the mouth. These infections may present as small blisters or scales and often cause significant discomfort.

Dermatophytes, another group of fungi, are responsible for conditions like athlete’s foot (tinea pedis), which is characterized by itchy, peeling skin and sometimes painful cracks, especially between the toes. Diabetics are also at higher risk for fungal nail infections, leading to thick, discolored, and brittle nails.

Preventing fungal infections involves keeping skin clean and dry, wearing breathable clothing, and changing socks regularly. Good glycemic control is also vital, as high blood sugar fuels fungal growth. If a fungal infection develops, prompt medical treatment with antifungal creams or oral medications is crucial. For more prevention tips and information, refer to the CDC’s guide to fungal infections and diabetes.

10. Itching (Pruritus)

Itching, medically known as pruritus, is a common complaint among people with diabetes. This persistent itchiness often results from dry skin and poor circulation, both of which are frequent complications of chronically elevated blood sugar. Reduced blood flow can deprive the skin of necessary nutrients and moisture, leading to dryness, flakiness, and increased sensitivity. Additionally, nerve damage (diabetic neuropathy) may alter skin sensation and exacerbate itching.

One example of diabetes-related pruritus is the development or worsening of eczema, where patients experience inflamed, itchy patches that may crack, ooze, or become infected. These symptoms are often more pronounced on the lower legs, feet, or arms, where circulation is typically poorest in diabetic individuals.

To manage and prevent itching, establishing a regular moisturizing routine is essential. Use fragrance-free, gentle moisturizers immediately after bathing to lock in moisture. Avoid hot showers and harsh soaps, as these can strip the skin’s natural oils. Wearing soft, breathable fabrics can also reduce irritation. If itching persists or is accompanied by redness, swelling, or open sores, seek medical advice. For further guidance on managing pruritus in diabetes, visit the American Diabetes Association’s skin complications page.

11. Vitiligo

Vitiligo is a skin disorder characterized by the loss of pigment in patches, resulting in irregular, milky-white areas on the skin. These depigmented patches can appear anywhere on the body but are most commonly seen on the hands, face, and areas around body openings such as the mouth and eyes. The condition occurs when melanocytes, the cells responsible for producing skin pigment (melanin), are destroyed.

Vitiligo has a strong autoimmune component and is more frequently found in individuals with other autoimmune conditions, including Type 1 diabetes. In people with Type 1 diabetes, the immune system mistakenly attacks not only insulin-producing cells in the pancreas but may also target skin cells, leading to vitiligo. This connection highlights the importance of monitoring for additional autoimmune symptoms in diabetic patients.

While vitiligo is not physically harmful, the loss of pigmentation makes affected skin more vulnerable to sunburn. Therefore, individuals with vitiligo should use broad-spectrum sunscreen and protective clothing to shield depigmented areas from sun exposure. For more information about vitiligo, its connection to autoimmune diseases, and sun protection tips, visit the National Institute of Arthritis and Musculoskeletal and Skin Diseases’ page on vitiligo.

12. Skin Tags (Acrochordons)

Skin tags, medically known as acrochordons, are small, soft, flesh-colored growths that typically appear on the neck, eyelids, armpits, groin, and under the breasts. These harmless growths are attached to the skin by a thin stalk and can range in size from a few millimeters to a centimeter or more. Research indicates that skin tags are more common among people with diabetes, particularly those with insulin resistance or obesity. Elevated insulin levels are believed to stimulate the growth of skin cells, contributing to the formation of these benign lesions.

While skin tags are generally painless and do not pose a health risk, they can become irritated by friction from clothing, jewelry, or shaving. In some cases, skin tags may bleed or become infected if repeatedly traumatized. Removal is typically only recommended when skin tags cause discomfort, cosmetic concern, or recurrent irritation. Removal procedures—such as snipping, freezing, or burning—should always be performed by a healthcare professional to prevent complications.

If you notice a sudden increase in the number or size of skin tags, it may be worthwhile to discuss this with your healthcare provider, as it can be a marker of underlying insulin resistance. For more information, visit the American Academy of Dermatology Association’s page on skin tags.

13. Lichen Planus

Lichen planus is an inflammatory skin condition marked by purplish, flat-topped, and intensely itchy bumps that often develop on the wrists, lower back, ankles, and shins. These lesions may appear suddenly and can merge to form larger patches. In addition to the skin, lichen planus frequently affects the mucous membranes, especially inside the mouth, where it presents as white, lacy patches or painful sores. Fingernails and toenails can also be involved, sometimes resulting in ridging or thinning.

While the exact cause of lichen planus remains unclear, it is considered to have an autoimmune basis and is more commonly observed in individuals with diabetes, particularly type 1. The chronic inflammation associated with diabetes may predispose the immune system to mistakenly attack healthy skin and mucosal tissues, resulting in the characteristic symptoms of lichen planus.

Oral lichen planus can make eating and speaking uncomfortable, and it may persist for months or even years if not properly managed. If you notice purplish bumps or persistent mouth sores, consult a healthcare provider for evaluation and management. For further details on lichen planus and its association with diabetes, visit the Mayo Clinic’s guide to lichen planus.

14. Scleredema Diabeticorum

Scleredema diabeticorum is a rare skin condition that primarily affects individuals with long-standing or poorly controlled diabetes, particularly middle-aged or older adults with type 2 diabetes. This disorder is characterized by a progressive thickening and hardening of the skin, most notably on the back of the neck, upper back, and sometimes extending to the shoulders and upper arms. The affected skin appears swollen, stiff, and sometimes has a woody texture. Unlike other forms of skin thickening, scleredema diabeticorum does not usually affect the hands or feet.

The exact cause of scleredema diabeticorum is not fully understood, but it is believed to be associated with chronic high blood sugar, which leads to changes in collagen and other components of the skin’s connective tissues. Although this condition is rare, it can significantly restrict movement and cause discomfort or pain in the affected regions.

Management primarily involves achieving better glycemic control, which may help slow or halt the progression of skin thickening. In some cases, physical therapy and moisturizers may be recommended to maintain skin flexibility. For further information on scleredema diabeticorum and its connection to diabetes management, visit the DermNet NZ’s page on scleredema.

15. Allergic Reactions to Insulin

Allergic reactions to insulin are uncommon but can occur in individuals managing diabetes with insulin therapy. These reactions typically present as localized skin issues at the site of injection, such as redness, swelling, itching, or the formation of hives. In rare cases, more widespread or systemic allergic responses may occur, including generalized rash, difficulty breathing, or anaphylaxis, though these are exceedingly rare with modern, purified insulin preparations.

Examples of local skin reactions include small, itchy bumps or plaques that develop shortly after insulin administration and may persist for hours or even days. Some patients may also notice lipodystrophy—areas of thickened or sunken skin due to repeated injections—which is not an allergic reaction but can be mistaken for one.

If you experience persistent or severe skin reactions at your injection sites, it is important to consult your healthcare provider. Management may involve adjusting the injection technique, rotating sites, switching to a different type or brand of insulin, or, in rare cases, using antihistamines or desensitization protocols. For more information on recognizing and managing allergic reactions to insulin, visit the Mayo Clinic’s insulin therapy resource.

16. Lipoatrophy and Lipohypertrophy

Lipoatrophy and lipohypertrophy are two distinct skin changes that can occur at insulin injection sites in individuals with diabetes. Lipoatrophy refers to localized loss of subcutaneous fat, resulting in visible indentations or depressions at the injection site. In contrast, lipohypertrophy is the accumulation of fat, producing thickened, rubbery, or lump-like areas under the skin. Both conditions can alter the appearance and texture of the skin compared to the surrounding normal, smooth tissue.

Lipoatrophy is less common with modern insulins but can occur as an immune-mediated reaction to insulin, leaving sunken patches that may be cosmetically concerning and alter insulin absorption. Lipohypertrophy, on the other hand, is more frequent and often develops when injections are repeatedly administered in the same area, making insulin absorption unpredictable and potentially leading to erratic blood glucose levels.

To minimize these complications, it is crucial to rotate injection sites regularly, using different areas on the abdomen, thighs, upper arms, and buttocks. This practice allows the skin and underlying fat to recover and helps maintain consistent insulin absorption. For more guidance on injection technique and site rotation, visit the American Diabetes Association’s injection know-how page.

17. Poor Wound Healing

Poor wound healing is a serious concern for individuals with diabetes, primarily due to the damaging effects of persistently high blood sugar levels on blood vessels and the immune system. Elevated glucose impairs the ability of white blood cells to fight infection and delays the formation of new tissue, which is critical for closing wounds. Additionally, reduced blood flow, especially to the extremities, deprives injured areas of oxygen and nutrients necessary for healing.

A common and potentially dangerous example is the diabetic foot ulcer. These open sores, often located on the bottom of the feet or toes, can develop from even minor cuts, blisters, or pressure points. Due to neuropathy, individuals may not feel pain or notice injuries until they become serious. If not promptly and properly treated, foot ulcers can become infected and may ultimately require surgical intervention or amputation.

Daily monitoring of the skin, especially on the feet, is essential for early detection and intervention. Proper wound care, maintaining blood glucose targets, and seeking medical attention for any slow-healing or worsening wounds are vital steps. For more information on wound care and prevention, see the CDC’s guide to healthy feet for people with diabetes.

18. Diabetic Foot Ulcers

Diabetic foot ulcers are open sores or wounds that typically develop on the bottom of the feet in people with diabetes. The main causes are a combination of peripheral neuropathy (nerve damage), which reduces sensation, and peripheral arterial disease, which impairs blood flow. As a result, minor injuries from pressure, friction, or trauma can go unnoticed and progress into deeper wounds. The risk is further compounded by poor glycemic control and improper foot care.

Foot ulcers progress through stages, beginning as superficial sores and advancing to deeper ulcers that may expose muscle or bone if left untreated. Early-stage ulcers might look like shallow, red sores, while advanced ulcers often show signs of infection, such as pus, foul odor, and surrounding tissue damage. These wounds can lead to severe complications, including cellulitis, gangrene, and an increased risk of amputation if infection spreads or healing does not occur.

Regular foot exams are crucial for early detection and prevention. Individuals with diabetes should inspect their feet daily for blisters, cuts, or discoloration and seek prompt medical care for any abnormalities. For comprehensive information on foot ulcer management and prevention, visit the American Podiatric Medical Association’s page on diabetic ulcers.

19. Calluses (Hyperkeratosis)

Calluses, medically known as hyperkeratosis, are areas of thickened skin that develop as a protective response to repeated pressure or friction. In people with diabetes, calluses most commonly form on the soles of the feet, especially over bony prominences or high-pressure areas. The risk of callus formation is significantly increased by peripheral neuropathy, a condition where nerve damage impairs sensation. Without normal pain feedback, individuals may not notice excessive pressure or ill-fitting shoes, leading to the gradual development of thick, hard callused skin.

While calluses themselves are not dangerous, they can become problematic if not managed properly. Excessively thick calluses may crack, causing pain or providing a site for bacterial entry and potential ulceration. Furthermore, calluses can mask underlying foot ulcers, which can be especially hazardous for people with diabetes.

Wearing properly fitted footwear is essential to prevent excessive pressure and friction on vulnerable areas of the feet. Regular foot inspections and professional care from a podiatrist can help control callus formation and prevent complications. For more guidance on callus care and diabetic foot health, visit the American Podiatric Medical Association’s diabetes resources.

20. Cracked Heels (Fissures)

Cracked heels, or heel fissures, are a frequent issue among people with diabetes. This condition occurs when the skin on the heels becomes excessively dry, thickened, and loses its elasticity, resulting in splits or cracks. Diabetes often impairs the body’s ability to maintain moisture in the skin, and neuropathy can further reduce sweat production, making feet more prone to dryness than in non-diabetic individuals. Unlike ordinary dry skin, diabetic skin may be more brittle and less able to heal small cracks, increasing the risk of deeper fissures and infections.

Cracked heels can be painful and, if left untreated, may progress to open wounds that allow bacteria to enter, leading to cellulitis or even more serious foot complications. The risk is heightened when calluses develop around the heel, adding pressure and increasing the likelihood of splitting.

Self-care for cracked heels includes daily moisturizing with thick, fragrance-free creams, gently removing thickened skin with a pumice stone, and wearing supportive shoes that protect the heels. Avoid walking barefoot, as this can worsen fissures. If cracks become deep, bleed, or show signs of infection, seek medical attention. For more self-care advice, visit the American Diabetes Association’s skin complications resource.

21. Peripheral Neuropathy Skin Changes

Peripheral neuropathy, a common complication of diabetes, leads to significant changes in skin health. Nerve damage caused by elevated blood glucose levels can impair the function of sweat glands, resulting in chronically dry, cracked, or flaky skin—especially on the feet and lower legs. The loss of protective sensation due to neuropathy means that individuals may not feel minor injuries, burns, or pressure sores, allowing these issues to progress unnoticed and potentially develop into ulcers or infections.

Numbness and tingling are hallmark symptoms of peripheral neuropathy, often accompanied by skin that appears thin, shiny, or lacks normal hair growth. Injuries such as cuts, blisters, or abrasions may go untreated, increasing the risk for serious complications. In severe cases, even small wounds can quickly become infected or fail to heal, highlighting the importance of proactive skin care.

Daily skin checks are crucial for those with peripheral neuropathy. Inspect feet, toes, and other at-risk areas for redness, swelling, blisters, or open sores, and seek prompt medical attention for any abnormalities. For more information on recognizing and managing neuropathic skin changes, visit the National Institute of Diabetes and Digestive and Kidney Diseases’ guide to diabetic neuropathy and foot care.

22. Eczema (Atopic Dermatitis)

Eczema, also known as atopic dermatitis, is a chronic inflammatory skin condition that is more prevalent among people with diabetes. Elevated blood sugar can impair the skin’s natural barrier, increasing susceptibility to dryness, irritation, and inflammation—hallmarks of eczema. Individuals with diabetes often report patches of red, itchy, and scaly skin, particularly on the arms, legs, and trunk. These symptoms may be aggravated by poorly controlled glucose levels, which contribute to persistent dryness and delayed skin healing.

A typical clinical scenario might involve an adult with type 2 diabetes who develops intensely itchy, dry patches on the lower legs during winter. Despite using over-the-counter lotions, the symptoms persist, leading to scratching, cracked skin, and sometimes secondary infection. This highlights the importance of targeted eczema management in the context of diabetes.

To reduce eczema flares, a consistent moisturizing routine is essential. Use fragrance-free, hypoallergenic moisturizers immediately after bathing to lock in moisture. Avoid hot water, harsh soaps, and irritants. Wearing soft, breathable clothing and maintaining good blood sugar control also support skin health. For more information on managing eczema with diabetes, visit the American Academy of Dermatology Association’s page on atopic dermatitis.

23. Psoriasis

Psoriasis is a chronic autoimmune skin disorder characterized by the rapid buildup of skin cells, resulting in thick, red plaques with silvery scales. Research has shown that psoriasis occurs more frequently in people with diabetes, especially type 2, likely due to shared inflammatory pathways and the increased prevalence of metabolic syndrome in both conditions. The immune dysregulation associated with diabetes can exacerbate psoriasis, making flares more frequent or severe.

Psoriatic plaques most commonly develop on the elbows, knees, scalp, and lower back, but they can appear anywhere on the body. Individuals with both diabetes and psoriasis may find their skin more prone to cracking, bleeding, and secondary infection. Additionally, psoriasis can negatively impact quality of life, sometimes leading to emotional distress or sleep disturbances.

A dermatology referral is particularly important if you notice rapidly spreading plaques, involvement of sensitive areas (such as the face or genitals), significant discomfort, or if over-the-counter treatments are ineffective. Early intervention can help control symptoms and reduce the risk of complications. To learn more about the link between psoriasis and diabetes, as well as available treatments, visit the National Psoriasis Foundation’s resource on psoriasis.

24. Skin Discoloration

Skin discoloration, manifesting as either hyperpigmentation (darkening) or hypopigmentation (lightening), is a common but often overlooked issue in people with diabetes. Fluctuations in blood sugar can damage small blood vessels and affect skin cell turnover, leading to changes in pigment distribution. Hyperpigmentation may appear as dark patches or streaks, sometimes in areas exposed to friction or insulin injections, while hypopigmentation can create pale or white spots, particularly following episodes of inflammation or prior skin injury.

Certain diabetes-related skin conditions, such as acanthosis nigricans and post-inflammatory changes from chronic eczema or psoriasis, often cause noticeable discoloration. These pigment changes may be gradual and subtle or, in some cases, more dramatic and cosmetically concerning. Importantly, sudden or widespread skin color changes could signal underlying vascular or autoimmune complications that require further evaluation.

If you notice new, persistent, or spreading areas of discoloration—especially when accompanied by other symptoms such as itching, pain, or ulceration—it’s essential to consult a healthcare provider. Early assessment can help rule out more serious causes and guide effective treatment. For more information, visit the American Academy of Dermatology Association’s resource on skin discoloration.

25. Skin Ulcers Beyond Feet

While diabetic ulcers are most commonly associated with the feet, they can also develop on the hands, legs, or other areas subjected to repeated trauma or pressure. These non-foot ulcers often result from the same underlying problems that cause foot ulcers: poor blood circulation (peripheral vascular disease), nerve damage (neuropathy), and impaired immune response due to chronic high blood sugar. Even minor cuts, scrapes, or burns on the hands or elsewhere can progress to non-healing ulcers in people with diabetes, especially when blood flow is compromised or sensation is reduced.

Ulcers outside the feet may appear as persistent open sores, often surrounded by discolored or thickened skin. They can be slow to heal and are at increased risk for infection, particularly if wound care is delayed. The risk is heightened in areas where circulation is naturally poorer or where repeated friction occurs, such as the hands for those who perform manual labor or in areas exposed to repetitive minor injuries.

Early and meticulous wound care is essential to prevent complications. Clean any skin break promptly, monitor for signs of infection, and seek medical attention if healing does not occur within a reasonable timeframe. For additional guidance, visit the WoundSource’s article on diabetic skin ulcers beyond the feet.

26. Xerosis (Generalized Dry Skin)

Xerosis, or generalized dry skin, is a common and sometimes severe problem for people with diabetes. It is characterized by widespread dryness, flaking, roughness, and sometimes fine cracks or fissures in the skin. Unlike the mild, gradual dryness that can occur with aging, diabetic xerosis tends to be more pronounced and persistent, affecting large areas of the body, including the legs, arms, and torso. The underlying cause is multifactorial: high blood sugar levels can draw moisture out of the skin, while nerve damage can reduce sweat and oil production, compounding the problem.

Diabetic xerosis can lead to itchy, uncomfortable skin and increases the risk for secondary infections and slow-healing wounds. The dryness is often more severe than what is seen in typical age-related dryness, and it may not respond to ordinary moisturizers.

Effective management includes the use of thick, fragrance-free emollients or ointments applied immediately after bathing to trap moisture in the skin. Avoiding long, hot showers and using gentle, non-soap cleansers can also help preserve the skin’s natural barrier. For more information on xerosis and recommended skin care routines, visit the American Academy of Dermatology Association’s page on xerosis.

27. Perforating Disorders

Perforating disorders are a group of rare skin conditions that occur more frequently in individuals with diabetes and chronic kidney disease. These disorders, including Kyrle disease, perforating folliculitis, and elastosis perforans serpiginosa, are characterized by the abnormal elimination of dermal material (such as collagen or elastic fibers) through the epidermis, resulting in distinctive skin lesions. Kyrle disease, for example, presents as large, itchy papules or nodules with a central plug, most commonly on the limbs and trunk.

The link between perforating disorders and diabetes is not completely understood, but chronic metabolic disturbances and impaired wound healing are believed to play a role. These lesions can be intensely itchy, prone to secondary infection, and may become chronic without appropriate treatment. Unlike more common skin changes in diabetes, perforating disorders can be diagnostically challenging and are often mistaken for other pruritic or nodular conditions.

Specialist input from a dermatologist is essential for accurate diagnosis and management. Skin biopsies are often needed to confirm the condition and differentiate it from other skin diseases. For more information on perforating disorders and their association with diabetes, visit the DermNet NZ’s page on Kyrle disease.

28. Cheiroarthropathy (Diabetic Stiff Hand)

Cheiroarthropathy, also known as diabetic stiff hand syndrome, is a condition marked by thickening and tightening of the skin on the hands, accompanied by progressive joint stiffness and limited mobility. This complication arises from changes in collagen and connective tissue due to prolonged high blood sugar levels, leading to reduced elasticity in the skin and underlying tissues. The fingers may become difficult to straighten fully, and the skin can feel waxy or tight.

This condition shares some similarities with scleroderma, another disorder characterized by skin thickening and joint restriction, but cheiroarthropathy is specifically linked to diabetes. Unlike scleroderma, cheiroarthropathy generally does not involve internal organs and is largely limited to the hands and sometimes the fingers or forearms. The inability to press the palms together flat—known as the “prayer sign”—is a classic clinical finding.

To help preserve hand function, regular stretching and flexibility exercises are recommended. Occupational or physical therapy may be beneficial for maintaining joint range of motion and preventing further stiffness. Early recognition and intervention are crucial. For more details on diabetic stiff hand and recommended exercises, visit the American Diabetes Association’s page on skin complications.

29. Erysipelas

Erysipelas is an acute, rapidly spreading bacterial skin infection most commonly caused by Streptococcus bacteria. It presents as a bright red, swollen area of skin with distinct, raised edges that are clearly demarcated from the surrounding normal tissue. The affected area—often the face or lower legs—can be warm, tender, and sometimes accompanied by blisters or fever. People with diabetes are at increased risk for erysipelas due to impaired immune response, compromised skin barrier, and reduced blood flow that makes it easier for bacteria to invade and multiply.

The infection can develop quickly and may be mistaken for cellulitis, but the sharply defined, elevated borders are characteristic of erysipelas. If untreated, the bacteria can spread rapidly through the lymphatic system, leading to systemic illness or complications such as abscess formation and sepsis.

Immediate medical attention and prompt initiation of antibiotic therapy are crucial for successful treatment and to prevent complications. Hospitalization may be required in severe or rapidly progressing cases, especially for those with diabetes. For more information on erysipelas, symptoms, and the importance of urgent care, visit the Merck Manual’s overview of erysipelas.

30. Cellulitis

Cellulitis is a potentially serious bacterial infection that affects the deeper layers of the skin and underlying soft tissues. It is especially concerning for people with diabetes, as compromised immune function and poor circulation increase susceptibility to infection and slow recovery. Cellulitis typically presents as a red, swollen, warm, and tender area of skin, most often on the legs or feet. Unlike erysipelas, which features sharply raised and well-defined borders, cellulitis tends to have indistinct, less elevated edges and can spread more diffusely through the tissues.

This infection often arises after a break in the skin, such as a cut, ulcer, or insect bite, but may also develop without an obvious source. In people with diabetes, cellulitis can progress rapidly and lead to serious complications, including abscesses, tissue death, and sepsis if not promptly treated. Signs that require urgent medical attention include rapidly expanding redness, severe pain, fever, chills, blisters, or red streaks moving away from the affected area.

Immediate medical evaluation and antibiotic treatment are necessary to prevent further complications and reduce the risk of hospitalization. To learn more about cellulitis and its management, visit the CDC’s cellulitis information page.

31. Intertrigo

Intertrigo is a common inflammatory condition that affects the skin folds, such as those under the breasts, in the groin, between the buttocks, and beneath the abdomen. It presents as painful, red, and moist rashes that can sometimes ooze or develop a foul odor. People with diabetes are particularly susceptible due to increased moisture, friction, and warm environments in these areas, combined with a weakened immune system and higher blood sugar levels that promote microbial growth.

Intertrigo often arises when sweat and skin-on-skin contact create a perfect environment for fungal (especially Candida) and bacterial overgrowth. These secondary infections can worsen inflammation, cause itching or burning, and delay healing. Chronic intertrigo may also lead to skin breakdown, ulceration, or persistent discomfort if not properly managed.

Good hygiene practices are essential for prevention and management. Keep affected areas clean and dry, use absorbent powders or moisture-wicking fabrics, and avoid tight clothing. If the rash persists or shows signs of infection—such as pus, severe redness, or spreading—seek medical attention for possible antifungal or antibiotic treatment. For more tips and information, visit the American Academy of Dermatology Association’s page on intertrigo.

32. Onychomycosis (Fungal Nail Infection)

Onychomycosis is a common fungal infection of the nails, especially prevalent in people with diabetes. This condition causes nails—most often on the toes—to become thickened, brittle, yellow or brown, and sometimes crumbly or separated from the nail bed. The same types of fungi responsible for athlete’s foot (tinea pedis) frequently cause onychomycosis, and the two conditions often coexist. However, while athlete’s foot affects the skin between the toes and the soles, onychomycosis specifically targets the nail itself, making it harder to treat.

Fungal nail infections can be more than just a cosmetic problem for people with diabetes. Thickened, distorted nails may create pressure points, leading to pain, difficulty walking, or secondary bacterial infections if the surrounding skin is broken. The risk of complications is higher due to impaired circulation and immune response, which can make infections harder to clear.

Podiatric care is strongly recommended for individuals with diabetes who notice changes in their nails. Early intervention with topical or oral antifungal medications, and regular trimming and care by a foot specialist, can help prevent complications. For more on diagnosis and management, visit the American Podiatric Medical Association’s diabetic nail care resource.

33. Bullous Pemphigoid

Bullous pemphigoid is a rare but serious autoimmune blistering disease that can occur in people with diabetes, especially older adults. This condition causes the immune system to mistakenly attack proteins in the skin’s basement membrane, resulting in large, tense, fluid-filled blisters that often appear on the abdomen, thighs, arms, or lower legs. Unlike the fragile blisters of diabetic bullae, the blisters in bullous pemphigoid are usually firm and do not rupture easily.

There is an established association between bullous pemphigoid and diabetes, particularly type 2, although the exact cause of this link remains unclear. The presence of additional autoimmune conditions, which are more common in diabetic individuals, may contribute to the increased risk. In some cases, the use of certain diabetes medications has also been implicated as a potential trigger.

Bullous pemphigoid requires prompt medical attention and long-term management. Treatment often involves corticosteroids and immunosuppressive medications to control inflammation and prevent new blisters. Early diagnosis and intervention are critical to minimize complications such as infection, scarring, and impaired mobility. For more information, visit the American Academy of Dermatology Association’s page on bullous pemphigoid.

34. Dermatitis Herpetiformis

Dermatitis herpetiformis is a chronic, intensely itchy, blistering skin condition strongly associated with celiac disease. People with type 1 diabetes are at a higher risk for both celiac disease and dermatitis herpetiformis due to shared autoimmune mechanisms. The rash appears as clusters of small, red bumps and blisters, most commonly on the elbows, knees, buttocks, and scalp. The itching can be intense, often leading to scratching and secondary skin infections.

This condition is an external manifestation of gluten sensitivity. When people with the genetic tendency for celiac disease consume gluten, the immune system attacks the skin, leading to characteristic blistering eruptions. Dermatitis herpetiformis can be mistaken for eczema or other itchy rashes, but its symmetrical distribution and association with celiac disease help differentiate it.

Managing dermatitis herpetiformis involves strict adherence to a gluten-free diet, which not only resolves the rash but also reduces the risk of intestinal damage. Medications such as dapsone may provide rapid symptom relief but do not address the underlying autoimmune trigger. If you suspect this condition, consult a healthcare provider for proper diagnosis and dietary guidance. For more information, visit the Celiac Disease Foundation’s page on dermatitis herpetiformis.

35. Pigmented Purpuric Dermatosis

Pigmented purpuric dermatosis is a group of chronic skin disorders characterized by the appearance of small, reddish-brown spots or patches, most commonly on the lower legs. These spots result from the leakage of red blood cells from small capillaries near the surface of the skin, which subsequently break down and leave behind deposits of hemosiderin, a pigment derived from hemoglobin. Although the condition is generally harmless and not associated with pain or itching, it can be a source of cosmetic concern, particularly for people with diabetes who may already have vascular fragility or circulatory issues.

Diabetes can increase the risk of developing pigmented purpuric dermatosis due to microvascular changes and chronic inflammation. The spots may persist for months or years and, in some cases, may be accompanied by slight skin dryness or scaling. While the condition is usually benign, sudden onset, rapid spreading, or the appearance of other symptoms such as pain or ulceration should prompt further evaluation.

If you notice new or unexplained reddish-brown patches, especially if they are persistent or worsening, it is advisable to see a dermatologist for proper diagnosis and management. For more information, visit the DermNet NZ’s page on pigmented purpuric dermatosis.

36. Stasis Dermatitis

Stasis dermatitis is a chronic inflammatory skin condition that occurs as a result of poor circulation in the lower legs, a problem that is more prevalent among people with diabetes. The underlying cause is usually venous insufficiency, in which weakened or damaged veins allow blood to pool in the legs instead of efficiently returning to the heart. This buildup increases pressure in the capillaries, causing fluid and proteins to leak into the surrounding tissues and trigger skin inflammation.

Stasis dermatitis typically presents as red, swollen, and sometimes scaly patches on the lower legs and ankles. The skin may feel tight, itchy, or tender, and in advanced cases, darkened pigmentation or open sores (venous ulcers) can develop. People with diabetes are particularly vulnerable due to the combined effects of microvascular disease, neuropathy, and increased risk for peripheral vascular disorders.

Management includes addressing the underlying circulatory problem. Regular leg elevation, compression stockings, and gentle skin care can help reduce swelling and inflammation. Avoid standing or sitting for prolonged periods, and seek prompt treatment for any skin breakdown. For more information, visit the Mayo Clinic’s page on stasis dermatitis.

37. Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is a chronic, inflammatory skin condition characterized by the development of painful, deep-seated lumps under the skin, typically in areas rich in sweat glands such as the armpits, groin, buttocks, and under the breasts. Over time, these lumps can rupture, leading to tunnels under the skin (sinus tracts), scarring, and persistent drainage. People with diabetes and metabolic syndrome are at increased risk for HS, likely due to shared inflammatory pathways, obesity, and insulin resistance.

The condition often begins after puberty and can significantly impact quality of life due to discomfort, embarrassment, and the risk of recurrent infections. Early symptoms may be mistaken for boils or simple abscesses, but HS tends to recur in the same locations and progressively worsen without treatment.

Early intervention is vital to managing HS and preventing long-term complications. Treatment options include weight management, smoking cessation, topical and oral antibiotics, and, in more severe cases, immunomodulatory medications or surgical procedures. Good hygiene and wearing loose, breathable clothing can also help reduce flare-ups. For more information, visit the American Academy of Dermatology Association’s page on hidradenitis suppurativa.

38. Cutaneous Candidiasis

Cutaneous candidiasis refers to superficial yeast infections caused by Candida species, most commonly Candida albicans. These infections are prevalent in individuals with diabetes, especially when blood sugar levels are poorly controlled. The condition typically affects moist, warm skin folds such as the armpits, groin, under the breasts, and between the fingers or toes. The affected areas become red, macerated, and may develop satellite pustules—small, raised bumps surrounding the main rash. The sensation is often itchy, burning, or sore.

Cutaneous candidiasis can be likened to diaper rash in infants, as both conditions are driven by prolonged moisture and friction in enclosed areas, promoting yeast overgrowth. In adults with diabetes, obesity and increased sweating further increase the risk. If left untreated, the rash can spread, become chronic, or lead to secondary bacterial infections.

Antifungal treatments—such as topical creams containing clotrimazole, miconazole, or nystatin—are effective for most cases. Keeping affected areas clean and dry, wearing loose, breathable clothing, and maintaining optimal blood glucose levels are key preventive strategies. For more information on cutaneous candidiasis and treatment options, visit the CDC’s candidiasis resource.

39. Folliculitis

Folliculitis is the inflammation or infection of hair follicles, leading to the formation of small, red, and sometimes pus-filled bumps on the skin. This condition is more common in people with diabetes due to a combination of impaired immune response, increased sweat, and higher blood sugar levels that promote bacterial or fungal growth. Folliculitis often occurs in areas subjected to shaving, friction from tight clothing, or frequent sweating—such as the face, scalp, thighs, buttocks, and underarms.

Symptoms include clusters of itchy or tender bumps, sometimes with a white tip, surrounded by a red halo. The bumps may break open and form crusts. While most cases are mild and self-limited, persistent or widespread folliculitis can lead to more serious skin infections or scarring, especially in those with poorly controlled diabetes.

Gentle skin care is crucial for prevention and management. Avoid shaving too closely, wear loose-fitting clothes, and keep the skin clean and dry. Antibacterial washes or topical antibiotics may be recommended for recurrent cases. If folliculitis does not resolve or worsens, consult a healthcare provider. For more information, visit the American Academy of Dermatology Association’s resource on folliculitis.

40. Boils (Furuncles)

Boils, medically known as furuncles, are deep, painful, pus-filled lumps that form when hair follicles become infected, usually by Staphylococcus aureus bacteria. People with diabetes are at higher risk for developing boils, particularly when blood sugar levels are poorly controlled. Elevated glucose impairs immune defenses, making it easier for bacteria to invade and multiply within hair follicles. Boils most commonly appear on areas prone to friction, sweating, or minor trauma, such as the neck, armpits, thighs, buttocks, and face.

Initially, a boil presents as a red, tender nodule that quickly enlarges and becomes more painful. Over several days, the center softens and fills with pus, which may eventually drain spontaneously. In some cases, boils cluster together, forming a larger abscess known as a carbuncle. The risk of complications—including deeper infection or spread to other body areas—is higher in those with diabetes.

Seek medical attention for large, recurrent, or persistent boils, or if fever and spreading redness develop. Incision and drainage by a healthcare provider may be necessary, along with antibiotics. Do not attempt to squeeze or lance boils at home. For more information, visit the Mayo Clinic’s guide to boils and carbuncles.

41. Carbuncles

Carbuncles are clusters of interconnected boils (furuncles) that form a larger, deeper, and more severe skin infection. This condition is characterized by multiple adjacent pus-filled nodules that merge beneath the skin, creating a painful, swollen mass. Carbuncles are most commonly caused by Staphylococcus aureus bacteria and frequently occur on the back of the neck, shoulders, thighs, or buttocks. People with diabetes are at increased risk due to impaired immune response and higher likelihood of skin breakdown and bacterial invasion.

Compared to a single boil, carbuncles are larger, more tender, and often accompanied by systemic symptoms such as fever, chills, and fatigue. The infection can spread more easily to the surrounding tissue or into the bloodstream, leading to potentially serious complications such as cellulitis or sepsis. The skin over a carbuncle may display multiple points of drainage as pus attempts to escape from several follicles at once.

Prompt medical care is essential for carbuncles, particularly in individuals with diabetes. Treatment typically involves incision and drainage by a healthcare professional, along with systemic antibiotics. Home treatment is not advised, as improper care can worsen the infection. For more details, visit the NHS resource on boils and carbuncles.

42. Herpes Zoster (Shingles)

Herpes zoster, commonly known as shingles, is a viral infection caused by the reactivation of the varicella-zoster virus—the same virus responsible for chickenpox. People with diabetes are at increased risk for shingles due to immune system suppression associated with chronic high blood sugar levels and other metabolic changes. The risk of developing shingles increases with age and in those with compromised immunity, making diabetic individuals particularly vulnerable.

Shingles typically presents as a painful, burning, or tingling sensation on one side of the body, followed by the appearance of a blistering rash. The rash usually forms a stripe or band along a nerve path, most often on the torso or face. The blisters eventually scab over, but the pain (postherpetic neuralgia) can persist for weeks or even months after the rash resolves. Other symptoms may include fever, headache, and fatigue.

Vaccination is an effective way to reduce the risk and severity of shingles, especially for adults over 50 and those with diabetes. The recombinant zoster vaccine (Shingrix) is recommended for most adults in this age group. For more information on shingles, symptoms, and vaccine options, visit the CDC’s herpes zoster (shingles) resource.

43. Molluscum Contagiosum

Molluscum contagiosum is a viral skin infection caused by a poxvirus, resulting in small, firm, flesh-colored or pearly bumps with a characteristic central dimple. These lesions are usually painless but may become red, itchy, or inflamed, particularly if scratched or irritated. While molluscum contagiosum can affect anyone, it is more persistent and widespread in people with diabetes due to the immune system’s reduced ability to clear viral infections.

Lesions typically appear on the trunk, arms, legs, or face and can sometimes be mistaken for warts or other benign skin growths. In diabetic individuals, molluscum contagiosum may last for months or even years, and the bumps are at higher risk for secondary bacterial infection if the overlying skin is broken.

Treatment is often not necessary as the bumps may eventually resolve on their own, but removal may be considered for cosmetic reasons, persistent lesions, or recurrent infections. Options include cryotherapy (freezing), curettage (scraping), topical therapies, or laser treatment—best performed by a dermatologist. Good skin hygiene and avoiding scratching can help prevent spread. For further information, visit the American Academy of Dermatology Association’s resource on molluscum contagiosum.

44. Delayed Scar Formation

Delayed or abnormal scar formation is a notable complication in individuals with diabetes, largely due to the impaired wound healing process associated with chronic high blood sugar. In normal healing, the body efficiently repairs damaged tissue, forming a scar within a predictable timeframe. However, in people with diabetes, factors such as poor circulation, reduced immune response, and altered collagen production can significantly slow or disrupt the formation of healthy scar tissue.

This delay may result in wounds that remain open for longer periods, increasing the risk for infection and the development of hypertrophic or atrophic scars—scars that are raised, sunken, or irregular in appearance. Even minor cuts or surgical incisions may take weeks or months to heal, and the final scar may be weaker or more prone to breakdown than in individuals without diabetes.

If you notice wounds that do not close, scars that seem abnormal, or signs of infection (such as redness, warmth, or drainage), it is important to consult a wound care specialist or healthcare provider. Early intervention can help promote healing and reduce complications. For more information, visit the Mount Sinai’s page on poor wound healing and scars.

45. Hyperkeratotic Skin Lesions

Hyperkeratotic skin lesions are thick, rough patches of skin that develop as a result of excessive buildup of keratin, the protein that forms the outermost layer of the skin. In people with diabetes, these lesions often appear on pressure points such as the soles of the feet, palms, or elbows. Prolonged high blood sugar, neuropathy, and poor circulation contribute to the formation of these lesions by impairing the skin’s natural turnover and repair processes. Repeated friction, pressure, or trauma—especially from ill-fitting footwear—can further increase the risk.

Hyperkeratotic lesions may present as calluses, corns, or plaques with a yellowish or grayish hue and a hard, crusty surface. While not usually painful initially, these lesions can crack, bleed, or become infected if not managed properly. In diabetes, the risk of complications is greater because of delayed healing and reduced sensation in affected areas.

Preventive skin care habits are crucial. These include wearing well-fitting shoes, regularly moisturizing thickened skin, and avoiding self-removal of calluses or corns. Routine foot inspections and professional podiatric care can help prevent serious complications. For more information, visit the American Academy of Dermatology Association’s resource on hyperkeratosis.

46. Perleche (Angular Cheilitis)

Perleche, also known as angular cheilitis, is a condition characterized by painful, red cracks or fissures at the corners of the mouth. These lesions can be accompanied by swelling, crusting, and sometimes bleeding, making eating, speaking, or smiling uncomfortable. Individuals with diabetes are particularly susceptible to perleche due to increased skin dryness, impaired immune function, and the higher likelihood of fungal overgrowth—especially Candida species—at moist, macerated areas.

Fungal or mixed bacterial-fungal infections commonly colonize these cracks, perpetuating inflammation and delaying healing. Factors such as drooling, wearing dentures, or frequent lip licking can exacerbate the problem by keeping the mouth corners moist. Poorly controlled blood sugar further promotes Candida growth and impedes recovery.

Prevention tips include maintaining good oral hygiene, managing blood glucose levels, and keeping the mouth corners as dry as possible. Using protective lip balms, correcting poorly fitting dentures, and avoiding excessive saliva buildup can also help. If perleche develops, antifungal or antibacterial creams prescribed by a healthcare provider are typically effective. Learn more about prevention and treatment at the American Academy of Dermatology Association’s page on angular cheilitis.

47. Prurigo Nodularis

Prurigo nodularis is a chronic skin condition characterized by intensely itchy, firm, raised nodules that can develop anywhere on the body but are most often found on the arms, legs, and trunk. In people with diabetes, persistent dryness, nerve dysfunction, and metabolic changes can predispose to this distressing disorder. The nodules are usually dome-shaped, range in color from red to brown, and may become thickened or crusted due to repetitive scratching and picking.

Unlike eczema, which often presents as widespread, flat patches of dry, inflamed skin, prurigo nodularis is marked by discrete, localized lumps that result from the ongoing itch-scratch cycle. The relentless itching can significantly impact quality of life, disrupt sleep, and lead to secondary skin infections or scarring. While eczema and prurigo nodularis may coexist, the presence of nodular lesions, especially in the setting of diabetes, should raise suspicion for prurigo nodularis.

Effective itch control is essential for breaking the cycle of scratching and nodule formation. Treatment may include topical steroids, antihistamines, or other medications under medical supervision. For further information and management strategies, visit the American Academy of Dermatology Association’s page on prurigo nodularis.

48. Skin Necrosis

Skin necrosis refers to the death of skin and underlying tissues, resulting from severe infections, vascular disease, or a combination of both. In people with diabetes, chronic high blood sugar can cause significant damage to blood vessels, reducing circulation and depriving skin tissues of essential oxygen and nutrients. Additionally, diabetes increases susceptibility to severe bacterial or fungal infections, which can further compromise tissue health. Necrosis most often develops in the lower extremities—such as the feet or toes—but can occur anywhere that blood flow is severely reduced or infection is unchecked.

Urgent warning signs of skin necrosis include rapidly spreading black or dark brown patches, loss of skin sensation, foul odor, swelling, blisters, and signs of systemic illness such as fever or confusion. Without immediate intervention, necrosis can progress to gangrene, sepsis, or even life-threatening complications requiring amputation.

Skin necrosis is a medical emergency requiring critical care. Early recognition and prompt treatment with antibiotics, surgical removal of dead tissue, and restoration of blood flow are essential for survival and limb preservation. For more on warning signs and emergency care, visit the Merck Manual’s page on gangrene and skin necrosis.

49. Skin Cancer Risk

People with diabetes may have an increased risk of developing certain types of skin cancers, including squamous cell carcinoma, basal cell carcinoma, and, to a lesser degree, melanoma. Chronic hyperglycemia, immune suppression, and higher rates of chronic inflammation are believed to contribute to this elevated risk. Additionally, diabetes can impair the body’s ability to detect and repair DNA damage caused by ultraviolet (UV) radiation, making sun protection especially important for those affected.

Sun safety practices are crucial for reducing the risk of skin cancer. These include wearing broad-spectrum sunscreen with SPF 30 or higher, using protective clothing and hats, avoiding tanning beds, and seeking shade during peak sunlight hours. People with diabetes should also be vigilant about checking their skin for new or changing lesions, unusual moles, non-healing sores, or growths that bleed or crust over.

Regular skin cancer screenings by a dermatologist are recommended, particularly for those with additional risk factors such as a history of sunburns, fair skin, or a family history of skin cancer. Early detection greatly improves treatment outcomes. For more information on diabetes and skin cancer prevention, visit the American Cancer Society’s sun safety resource.

50. Delayed Hair and Nail Growth

Delayed hair and nail growth is a subtle but important sign of circulatory problems in people with diabetes. Chronic high blood sugar can damage small blood vessels, reducing the delivery of oxygen and nutrients necessary for the healthy growth of hair and nails. As a result, individuals may notice that their hair grows more slowly, becomes thinner, or falls out more easily. Similarly, nails—especially those on the toes—may become brittle, thickened, or grow at a noticeably slower rate compared to the past.

For example, a person with diabetes might observe that their toenails require less frequent trimming or that new hair is slow to appear after shaving. These changes are often more pronounced in the lower extremities, where circulation is most likely to be impaired. Delayed hair and nail growth can also be associated with other complications such as peripheral artery disease or neuropathy.

It is important to report any significant changes in hair or nail growth to your healthcare provider, as these may signal underlying vascular or metabolic issues that require further assessment. For more information, visit the NIDDK’s resource on diabetic foot problems and related changes.

Conclusion

Monitoring skin health is a vital aspect of diabetes management, as early detection of skin changes can prevent serious complications. Regular self-examinations and professional skin checks enable individuals to identify new symptoms—such as rashes, sores, or unusual growths—before they become severe. Promptly reporting any changes to your healthcare provider ensures timely and effective intervention. Maintaining good blood glucose control, practicing daily skin care, and staying informed about potential risks all contribute to healthier skin and overall well-being. For further guidance on skin care and diabetes, visit the American Diabetes Association’s skin complications page.

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