Sometimes chronic illnesses come with symptoms we don’t expect. For example, diabetes can be accompanied by changes in the appearance or texture of your skin—and in some cases, may be an early clue that the illness is developing. Knowing the most common skin changes that can signal diabetes may help you get the diagnosis or treatment that you need.
Meet the experts: Brendan Camp, M.D., a dermatologist at MDCS Dermatology in New York; Shari Lipner, M.D., Ph.D., a dermatologist at Weill Cornell Medicine and NewYork-Presbyterian in New York City.
“Blood sugar levels can have a significant impact on the health and function of the skin,” says Brendan Camp, M.D., a dermatologist at MDCS Dermatology in New York. “Because the skin is a visible organ, it can sometimes provide clues that there are metabolic changes occurring elsewhere in the body.”
Read on to discover exactly how high blood sugar causes skin changes, plus the most common skin changes that accompany diabetes, who may experience them, and when you should give your doctor a call.
How blood sugar levels impact skin health
There are a few different ways that chronically high blood sugar levels may contribute to skin changes and conditions. “Chronically elevated blood glucose can affect small blood vessels, circulation, nerves, and the immune system, all of which play important roles in maintaining healthy skin and supporting wound healing,” Dr. Camp explains. More specifically, persistently high blood sugar creates an inflammatory environment that damages blood vessels, says Shari Lipner, M.D., Ph.D., a dermatologist at Weill Cornell Medicine and NewYork-Presbyterian in New York City, an environment that makes infections more likely to occur.
“Diabetes may also contribute to dehydration and changes in the skin barrier, which can make the skin more prone to dryness, itching, and irritation,” says Dr. Camp. He adds that in some cases, high blood sugar and insulin resistance can impact collagen production, resulting in more specific dermatologic issues.
Common skin changes that can signal diabetes
“Several skin changes can be associated with diabetes or insulin resistance, although none should automatically be assumed to mean that someone has diabetes,” Dr. Camp says. Here are the ones dermatologists see most often.
Acanthosis nigricans
“Acanthosis nigricans typically appears as darker, thicker, velvety skin, commonly around the neck, armpits, or groin,” explains Dr. Camp. “It is often associated with insulin resistance, because elevated insulin levels can stimulate growth and pigment-producing pathways within the skin.” According to the American Academy of Dermatology (AAD), acanthosis nigricans may be the first noticeable sign that you have prediabetes or diabetes.
Skin tags
When you have excess insulin in the body, it causes skin cells to overgrow, resulting in skin tags, explains Dr. Lipner. Per the AAD, these are most common on the eyelids, neck, armpits, and groin.
Dry, itchy skin
“People with diabetes may also experience dry, itchy skin, which can be related to dehydration, impaired circulation, and changes in the skin barrier,” explains Dr. Camp.
Shin spots
Shin spots, a.k.a. diabetic dermopathy, are faint, brown patches on the shins, Dr. Lipner says, which are related to the way that chronically high blood sugar affects the small blood vessels in the skin. Shin spots tend to feel scaly at first, per the AAD, and then may cause small dents in the skin. People with diabetes may also develop yellowish, reddish, or purplish patches on the shins that grow and become waxy in the middle—this condition is known as necrobiosis lipoidica and may be a sign that you have diabetes or that your diabetes is not well controlled.
Skin infections
“Skin infections, including bacterial and fungal infections, may occur more frequently because elevated blood sugar can impair aspects of the immune response and provide conditions that allow certain microorganisms to thrive,” Dr. Camp explains. The AAD notes that oral thrush and vaginal yeast infections are also common with diabetes.
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Slow-healing cuts, sores, or ulcers
“Diabetes can affect both circulation and nerve function, making an injury harder to detect and more difficult for the body to repair,” says Dr. Camp. The result is slow-healing injuries, particularly on the feet.
Yellowish bumps around the eyes
Technically called xanthelasma, these bumps may be a sign that your diabetes is poorly controlled, per the AAD. They’re caused by high levels of fat in your blood.
Eruptive xanthomatosis
Another sign that your diabetes is not well-controlled and the levels of fat in your blood are too high, this condition is characterized by an outbreak of small, tender, itchy bumps, according to the AAD. Once diabetes is under control, the bumps go away on their own.
Does everyone with diabetes have skin-related symptoms?
No, not everyone. “Only about a third of patients with diabetes develop specific skin findings,” says Dr. Lipner. “So while their presence would give higher suspicion of diabetes, not having them does not rule diabetes out, especially in people diagnosed early or with well-controlled disease.” Likewise, Dr. Camp adds that many of the skin changes associated with diabetes can also have other causes unrelated to changes in blood sugar, so experiencing one or more does not automatically point to the condition.
When do skin changes happen with diabetes?
It depends on the skin change. “Some changes associated with insulin resistance, such as acanthosis nigricans, can develop before a person has been formally diagnosed with type 2 diabetes and may serve as an early clue that further evaluation is warranted,” explains Dr. Camp. “Other problems, such as recurrent infections, poor wound healing, diabetic dermopathy, or foot ulcers, may be more likely to occur after diabetes has been present for some time, particularly when blood sugar is not well controlled or vascular and nerve complications have developed.”
Skin symptoms can also come and go, notes Dr. Lipner, especially if you are struggling to stabilize your blood sugar levels consistently. “Skin changes due to longer-term vessel and collagen damage, such as shin spots, may persist even after sugars are well managed,” she adds.
When to call your doctor
Any new, unexplained, and concerning changes to your skin are worth a call to your dermatologist. In the context of diabetes specifically, Dr. Camp says to look out for slow-healing wounds on the feet or lower legs, signs of infection like redness, warmth, or swelling, and any new areas of thick, velvety, or darkened skin. “Ultimately, dermatologic changes can provide useful information, but a physician can determine whether they are related to diabetes or another skin or medical condition and recommend the appropriate evaluation and treatment,” says Dr. Camp.
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