Your skin is your biggest organ—and your first defense against infection. Here's how to keep it healthy
When you have diabetes, you hear a lot about what goes on inside your body—how it uses the food you eat, how important controlling the glucose in your blood is to protect internal organs such as your heart and kidneys, and how diabetes treatments keep you healthy.
But have you ever thought about the outside of your body: your skin?
Your skin is the largest organ you have. It covers from 10 to 21 square feet, depending on how big you are, and accounts for roughly 12 to 15 percent of your weight. Not only does your skin provide your sense of touch, but it also helps regulate your body temperature and is your first line of protection against infection.
Unfortunately, diabetes can affect your skin, particularly if your blood glucose is not well controlled. "The problem with high blood glucose is that it can damage your nerves and the small blood vessels underneath your skin, and this can cause slow wound healing and make it easier to develop an infection," says Irwin Braverman, MD, professor of dermatology at the Yale University School of Medicine. "Then, if you get an infection, that can throw your diabetes [further] out of control."
Damage to small blood vessels can also cause a condition called diabetic dermopathy, which is characterized by light brown, scaly patches of skin. While unsightly, this skin condition is harmless and needs no treatment. Less common is a condition called necrobiosis lipoidica diabeticorum (NLD). In NLD, red spots eventually dull to look like a scar; the spots can be itchy and painful.
These conditions, along with wounds that are slow to heal, most often occur on the lower part of your body, mainly your legs and feet, says Stephen Webster, MD, a dermatologist at Gundersen Lutheran Medical Center in La Crosse, Wis., and a past president of the American Board of Dermatology. "It is very important to check your feet every day, top, bottom, and between your toes, for signs of injury and infection," he says.
Controlling your blood glucose is the best way to keep your skin healthy. But there are other steps you can take as well. These practices apply to good skin care for everyone, but because people with diabetes have a higher risk of infection and are more susceptible to common conditions such as fungal infections, it's important that you be vigilant in keeping your skin clean and resilient.
Make sure your skin is adequately hydrated, says Braverman. "Dry skin can itch, and when you scratch, it creates inroads for bacteria. In extreme cases, dry skin can crack."
To prevent this, bathe in tepid water. "In just five or 10 minutes, your skin will soak up water. The outer layer acts like a sponge," Braverman says. He cautions against long hot showers, as they can dry out the skin. Experts agree that water does more for your skin externally than internally: Capturing moisture with a good lotion after you bathe is a better way of keeping your skin supple than drinking eight glasses of water a day, as is sometimes recommended.
A good moisturizer is your skin's best friend, says Webster. "When you come out of the bath or shower, pat your skin gently with a towel and apply a moisturizing lotion or cream within three to five minutes, while your skin is still slightly damp," he says. "This will lock in the moisture."
Although choosing a cream or lotion is a matter of personal preference, Webster notes that different products are more appropriate for different areas of your body. "Creams work well on the body, but we often tell people to use a lighter lotion on the face," he says. "Avoid creams on the feet. When you sweat, they can waterlog your feet and eventually dry them out." You'll want to make sure your feet are completely dry and use only the lightest lotion.
Your needs may also change with the seasons. "Creams work well in the winter, when indoor air can dry your skin out," says Daniela Kroshinsky, MD, instructor in dermatology at Harvard Medical School and assistant in dermatology at Massachusetts General Hospital. "In the summer, you might want to use a lighter lotion. The air has more moisture in it, so you don't need as much." She adds that if you have patches of dry skin that are particularly tough to soften, your doctor can prescribe a special lotion or cream. "Prescription-strength moisturizers with a gentle acid like urea can help dissolve dry skin that builds up on the surface and causes cracks."
Experts agree: Don't use harsh, heavily scented soaps, which can irritate and dry out your skin, as can products containing preservatives. "Most lotions have two main components—oil and water—and manufacturers use preservatives to keep them from going rancid and separating," says Webster. "Instead, opt for hypoallergenic products. They usually contain fewer preservatives and no fragrance or color."
Hypoallergenic options that are widely available include lotions and creams from Curel, Lubriderm, and Neutrogena. If you wear makeup, Almay, Clinique, and Neutrogena products have fewer preservatives and include hypoallergenic cosmetics.
Treat Wounds Promptly
Because diabetes can hinder your ability to heal and raise your risk of infection, treat even the smallest cuts and scrapes promptly. Clean the wound and apply an antibiotic ointment, gel, or cream such as bacitracin, and then keep the injury covered. Webster points out that neomycin, while effective, is more likely than other topical antibiotics to cause an allergic reaction. Handle blisters gently, he adds. "It's OK to pierce a blister on the side and let the fluid out, but don't peel the top off. That is a protective cover."
In general, common sense is key, Braverman notes. "If the area doesn't seem to be improving within a couple of days, then I would see a doctor," he says. "Likewise if the area is hot to the touch, red, getting more painful, or showing obvious signs of infection like pus or oozing."
An SPF of 30 or higher is best for all exposed skin, including your face and hands, even in the winter, says Kroshinsky. "In the summer," she adds, "apply [sunscreen] every hour when you're swimming and immediately after toweling off when you come out of the water." Diabetes doesn't increase your susceptibility to sunburn, but if you blister or peel, you are more likely than people without diabetes to get an infection.
Don't Forget Your Nails
Your nails and cuticles are made of keratin, the same protein that makes up your skin, so it's important to take care of them, too, says Webster. Toenails should be cut straight across and fingernails should be filed smoothly to reduce the risk of rough edges catching on clothing or other materials, tearing the nail down to the quick and causing a wound.
"Cuticles should not be cut, ever," says Kroshinsky. "There is very little tissue between the skin on the tops of your fingers and the bone. Cutting your cuticles can allow bacteria and fungus to get in, and an infection there can become an infection of the bone." Webster recommends that you gently rub your choice of lotion or cream into your nails and cuticles as part of your post-bath moisturizing.
One-third of people with diabetes will develop a skin disorder caused or affected by the disease at some point in their lives, according to the American Diabetes Association. However, controlling your blood glucose and adding skin care to your daily routine will improve your chances of avoiding such problems—and help preserve your healthy glow.