DIABETES: 12 WARNING SIGNS THAT APPEAR ON YOUR SKIN

 Website content extracted from: Diabetes: 12 warning signs that appear on your skin (aad.org)

Diabetes can affect many parts of your body, including your skin. When diabetes affects the skin, it’s often a sign that your blood sugar (glucose) levels are too high. This could mean that:

• You have undiagnosed diabetes, or pre-diabetes

• Your treatment for diabetes needs to be adjusted

If you notice any of the following warning signs on your skin, it’s time to talk with your doctor.

1. Yellow, reddish, or brown patches on your skin

Necrobiosis Lipoidica

This skin condition often begins as small raised solid bumps that look like pimples. As it progresses, these bumps turn into patches of swollen and hard skin. The patches can be yellow, reddish, or brown.

You may also notice:

• The surrounding skin has a shiny porcelain-like appearance
• You can see blood vessels
• The skin is itchy and painful
• The skin disease goes through cycles where it is active, inactive, and then active again

The medical name for this condition is necrobiosis lipodica.

Take action

---

• Get tested for diabetes, if you have not been diagnosed.
• Work with your doctor to better control your diabetes.
• See a dermatologist about your skin. Necorbiosis lipodica is harmless, but it can lead to complications.

---

2. Darker area of skin that feels like velvet

A dark patch (or band) of velvety skin on the back of your neck, armpit, groin, or elsewhere could mean that you have too much insulin in your blood. This is often a sign of prediabetes. The medical name for this skin condition is acanthosis nigricans.

Acanthosis Nigricans (AN)

Often causing darker skin in the creases of the neck, AN may be the first sign that someone has diabetes.

Take action

---

• Get tested for diabetes

---

3. Hard, thickening skin

When this develops on the fingers, toes, or both, the medical name for this condition is digital sclerosis.

On the hands, you’ll notice tight, waxy skin on the backs of your hands. The fingers can become stiff and difficult to move. If diabetes has been poorly controlled for years, it can feel like you have pebbles in your fingertips.

Hard, thick, and swollen-looking skin can spread, appearing on the forearms and upper arms. It can also develop on the upper back, shoulders, and neck. Sometimes, the thickening skin spreads to the face, shoulders, and chest.

In rare cases, the skin over the knees, ankles, or elbows also thickens, making it difficult to straighten your leg, point your foot, or bend your arm. Wherever it appears, the thickened skin often has the texture of an orange peel.

This skin problem usually develops in people who have complications due to diabetes or diabetes that is difficult to treat.

Take action

---

• Tell your doctor about the thickening skin. Getting better control of your diabetes can bring relief.
• You may also need physical therapy. When the thickening skin develops on a finger, toe, or other area with joints, physical therapy can help you keep your ability to bend and straighten the joint.

---

4. Blisters

It’s rare, but people with diabetes can see blisters suddenly appear on their skin. You may see a large blister, a group of blisters, or both. The blisters tend to form on the hands, feet, legs, or forearms and look like the blisters that appear after a serious burn. Unlike the blisters that develop after a burn, these blisters are not painful.



Blisters

Large blisters like this one can form on the skin of people who have diabetes.

The medical name for this condition is bullosis diabetricorum. Sometimes, it’s called diabetic bullae.

Take action

---

• Tell your doctor about the blisters. You’ll want to take steps to prevent an infection.
• Talk with your doctor about how to better control your diabetes.

---

5. Skin infections

People who have diabetes tend to get skin infections. If you have a skin infection, you’ll notice one or more of the following:

• Hot, swollen skin that is painful
• An itchy rash and sometimes tiny blisters, dry scaly skin, or a white discharge that looks like cottage cheese

A skin infection can occur on any area of your body, including between your toes, around one or more of your nails, and on your scalp.

Skin infections

Has it been a year or longer since your last period, and do you get several yeast infections each year? It’s possible that you have diabetes or pre-diabetes.

Take action

---

• Get immediate treatment for the infection.
• Tell your doctor if you have frequent skin infections. You could have undiagnosed diabetes.
• If you’ve been diagnosed with diabetes, you may need better control of it.

---

6. Open sores and wounds

Having high blood sugar (glucose) for a long time can lead to poor circulation and nerve damage. You may have developed these if you’ve had uncontrolled (or poorly controlled) diabetes for a long time.

Poor circulation and nerve damage can make it hard for your body to heal wounds. This is especially true on the feet. These open wounds are called diabetic ulcers.

Diabetes and feet

If you have diabetes, you should check your feet every day for sores and open wounds.

Take action

---

• Get immediate medical care for an open sore or wound.
• Work with your doctor to better control your diabetes.

---

7. Shin spots

This skin condition causes spots (and sometimes lines) that create a barely noticeable depression in the skin. It’s common in people who have diabetes. The medical name is diabetic dermopathy. It usually forms on the shins. In rare cases, you’ll see it on the arms, thighs, trunk, or other areas of the body.

Shin spots

Diabetic dermopathy: This 55-year-old man has had diabetes for many years.

The spots are often brown and cause no symptoms. For these reasons, many people mistake them for age spots. Unlike age spots, these spots and lines usually start to fade after 18 to 24 months. Diabetic dermopathy can also stay on the skin indefinitely.

Take action

---

• Tell your doctor about these spots.
• Work with your doctor to better control your diabetes.
• If you haven’t been diagnosed with diabetes, get tested.

---

8. Outbreak of small, reddish-yellow bumps

When these bumps appear, they often look like pimples. Unlike pimples, they soon develop a yellowish color. You’ll usually find these bumps on the buttocks, thighs, crooks of the elbows, or backs of the knees. They can form anywhere though.

Eruptive-xanthomatosis

These bumps appear suddenly and clear promptly when diabetes is well-controlled.

When these bumps appear, they often look like pimples. Unlike pimples, they soon develop a yellowish color. You’ll usually find these bumps on the buttocks, thighs, crooks of the elbows, or backs of the knees. They can form anywhere though. No matter where they form, they are usually tender and itchy. The medical name for this skin condition is eruptive xanthomatosis.

Take action

---

• Tell your doctor about the bumps because this skin condition appears when you have uncontrolled diabetes.
• Talk with your doctor about how to better control your diabetes.

---

9. Red or skin-colored raised bumps

Whether this skin condition is associated with diabetes is controversial. We know that most people who have granuloma annulare do not have diabetes. Several studies, however, have found this skin condition in patients who have diabetes. One such study found that people with diabetes were most likely to have granuloma annulare over large areas of skin and that the bumps came and went. Another study concluded that people who have granuloma annulare that comes and goes should be tested for diabetes.

Granuloma annulare

This skin condition causes bumps and patches that may be skin-colored, red, pink, or bluish purple.

Take action

---

• Let your doctor know if you have bumps like those shown here, especially if the bumps come and go.

---

10. Extremely, dry itchy skin

Dry, itchy skin

If you have diabetes, you’re more likely to have dry skin. High blood sugar (glucose) can cause this. If you have a skin infection or poor circulation, these could also contribute to dry, itchy skin.

Take action

---

• Tell your doctor about your extremely dry skin. Gaining better control of diabetes can reduce dryness.
• If you continue to have dry skin after you gain better control of your diabetes, a dermatologist can help.

---

11. Yellowish scaly patches on and around your eyelids

These develop when you have high fat levels in your blood. It can also be a sign that your diabetes is poorly controlled. The medical name for this condition is xanthelasma.

Take action

---

• Tell your doctor about the yellowish scaly patches around your eyes.
• Talk with your doctor about how to better control your diabetes. Controlling diabetes can clear the scaly patches.

---

12. Skin tags

Many people have skin tags—skin growths that hang from a stalk. While harmless, having numerous skin tags may be a sign that you have too much insulin in your blood or type 2 diabetes.

Skin tags

These growths are most common on the eyelids, neck, armpit, and groin.

Take action

---

• Ask your doctor if you should get tested for diabetes.
• If you have diabetes, ask your doctor if you need better control of it.

---

When to see a dermatologist

Diabetes can cause many other skin problems. Most skin problems are harmless, but even a minor one can become serious in people who have diabetes. A board-certified dermatologist can recognize skin problems due to diabetes and help you manage them.

Are all dermatologists board certified?

No. See what it takes to become board certified.

What is a dermatologist?

---

Images
Image 1: Image Courtesy of Clark C. Otley, MD. All Rights Reserved

Images 3, 7, 8, 9: Used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

Image 2 from DermNetNZ

Some images used with permission of Journal of the American Academy of Dermatology

Images 5, 6 and 10: Getty Images

References
Cohen Sabban, EN. “Cutaneous manifestations of diabetes mellitus from A to Z.” Focus session presented at: 74th Annual Meeting of the American Academy of Dermatology; March 4-8, 2016; Washington D.C.

Duff M, Demidova O, et al. “Cutaneous manifestations of diabetes mellitus.” Clinical Diabetes. 2015;33:40-8.

Kalus AA, Chien AJ, et al. “Diabetes mellitus and other endocrine disorders.” In: Wolff K, Goldsmith LA, et al. Fitzpatrick’s Dermatology in General Medicine (seventh edition). McGraw Hill Medical, New York, 2008:1461-70.

McKinley-Grant L, Warnick M, et al. “Cutaneous manifestations of systemic disease.” In: Kelly AP and Taylor S. Dermatology for Skin of Color. (first edition). The McGraw-Hill Companies, Inc. China, 2009:481-4.

Morgan AJ and Schwartz RA. “Diabetic dermopathy: A subtle sign with grave implications.” J Am Acad Dermatol. 2008;58:447-51.

Yosipovitch G, Loh KC, et al. “Medical pearl: Scleroderma-like skin changes in patients with diabetes mellitus.” J Am Acad Dermatol. 2003;48:109-11.

How to Get Rid of Bags Under Your Eyes

 Website content extracted from: How to Get Rid of Bags Under Your Eyes | Johns Hopkins Medicine

Reviewed by: 

Shaun C. Desai, M.D.

Are you wondering why you have puffy eyes or how you can make under-eye bags disappear? Good news: Although they can be bothersome, bags under your eyes don’t usually impact vision or health. But if you want to reduce the puffiness around your eyes, there are temporary and long-lasting solutions.

What causes bags under the eyes?

There are several reasons people get puffy eyes, including:

• High-salt diet: Eating a lot of salty foods causes you to retain water and leads to swelling.
• Allergies: Congestion and inflammation from allergies can sometimes exacerbate under-eye puffiness.
• Medical conditions: Some health conditions such as thyroid problems can cause the eyes to become swollen.
• Genetics: Having under-eye bags can be a physical characteristic that runs in your family. 
• Natural aging process: Loss of firmness in the skin and muscles happens as you age.

Why under-eye bags form when you get older

“The most common cause of under-eye bags or puffiness is natural aging,” says Shaun Desai, M.D., a facial plastic and reconstructive surgeon at Johns Hopkins Center for Facial Plastic and Reconstructive Surgery. “Older skin becomes too lax and tends to fall or wrinkle. The muscles and tissues around the eye can also weaken and contribute to the baggy look. This weakening allows the fat surrounding the eye to bulge out, creating that bubble-like appearance.” 

Ways to Get Rid of Eye Bags

There are different approaches to reducing under-eye puffiness, depending on the cause. At-home treatments can temporarily shrink lower lids that are sometimes swollen from fluid pooling in the undereye area.
But, says Desai, home remedies and over-the-counter products can only do so much, “To effectively get rid of under-eye bags that are prominent and permanent, medical treatment is oftentimes necessary.” 

At-home treatments for puffy eyes

If you occasionally wake up with puffy lids, these quick fixes may help. They work to reduce swelling until it naturally subsides over the course of the day.

• Cold compresses: Cooling the area lessens inflammation and swelling by reducing blood flow. You can place anything cold, such as an ice pack, frozen bag of vegetables, chilled cucumber slices or refrigerated spoons, over closed eyes for a few minutes.
• Hemorrhoid creams: Some people pat over-the-counter creams designed for hemorrhoid treatment under their eyes. Product ingredients such as phenylephrine narrow blood vessels to reduce swelling. But use these products with caution: They may cause irritation in this sensitive area. Also, it’s important to keep this medication from getting in your eyes. 
• Caffeine: Caffeine is a vasoconstrictor, meaning it constricts blood vessels. Many cosmetics companies sell eye creams with caffeine to reduce under-eye puffiness. You can also try resting chilled tea bags (caffeinated black tea) on closed eyes.

Medical options for under-eye bags

If you’re fed up with under-eye bags, these medical treatments can improve and even eliminate them: 

Nonsurgical options
These noninvasive treatments smooth the under-eye area:

• Filler: This treatment places a filler material (usually hyaluronic acid, which is a jelly-like substance) where the under-eye area and cheek meet to create a smooth transition. The injection is performed in a doctor’s office under local anesthetic. Results last six to 12 months. 
• Laser resurfacing: This treatment uses a laser to remove surface layers of wrinkly skin in the under-eye area and stimulate new collagen growth, resulting in firmer skin. Results can last years, depending on your skin type and sun exposure. 
• Chemical peel: A chemical peel also treats wrinkly under-eye skin by removing superficial top layers. An in-office application of a chemical solution dissolves old skin cells to reveal tighter, brighter skin. Depending on your skin type and sun exposure, results can last a few years.

Surgical option
A lower eyelid lift (blepharoplasty) is an outpatient procedure where the surgeon readjusts the fat in the lower eye area and tightens the muscle and skin to create a smooth appearance. In most cases, a lower eyelid lift gets rid of under-eye bags for life — it’s rare for people to need future touch-ups.

However, says Desai, sometimes patients require multiple therapies to treat under-eye bags, such as combining laser resurfacing with filler or an eyelid lift.

How to Choose a Doctor

The eye area is a very delicate part of the face. Serious complications can arise if procedures are done improperly. It’s crucial to find a highly experienced, board-certified surgeon who specializes in treatment of the eyelid area.