Diabetic Ulcers: Early Warning Signs from Your Skin

Excerpted from
The DERMAdoctor Skinstruction Manual
By Audrey Kunin, M.D., Bill Gottlieb

Maybe you're not a doctor; your skin, however, is a diagnostician. As the largest and most expressive organ of the body, it can reveal an internal disorder, like diabetes or even cancer. And that's a tip-off you don't want to ignore, because the sooner you and your doctor attend to a health problem, the better off you'll be.

And if you already know you have a disease, your condition may have a skin manifestation that you and a doctor will need to deal with effectively.

Here's a guide to what your skin may be trying to tell you, along with some treatment information about disease-caused skin concerns.

Diabetes

Eighteen million Americans suffer from diabetes, a disease of uncontrolled blood sugar (glucose)-the incidence of which has increased by 50 percent in the past decade!

There are three types of diabetes. Type I, juvenile diabetes, is caused by a failure of the pancreas to produce insulin, a hormone that ushers blood sugar into the cells. Type II is due to insulin resistance: the body can't properly utilize the hormone. Ninety to 95 percent of people with diabetes have type II, and scientists think that in most cases it's a lifestyle disease caused by factors like being overweight, a diet high in sugars and fats, and lack of exercise. A third type of diabetes, gestational, affects 4 percent of pregnant women and is a risk factor for developing type II later in life.

Skin Symptoms of Diabetes

Dehydration. High levels of blood sugar cause the kidneys to draw water from the bloodstream, increasing urination. As a result, the skin becomes extremely dehydrated, inflamed, and cracked. Dehydrated skin is further worsened and complicated as poor nerve function (diabetic neuropathy) diminishes the production of sweat. While excessive sweating is undesirable, a normal level of sweating helps keep the skin moist.

Infection. Broken skin creates a portal of entry for infection-causing bacteria, fungi, and yeast, while uncontrolled blood sugars increase susceptibility to those infections. Diabetic patients are far more prone to developing many skin infections, including cellulitis (bacterial skin infections), athletes foot (a fungal infection), nail fungus, perleche (a yeast infection affecting the corners of the mouth), and intertrigo (a yeast infection arising within the skin folds).

Sensation. High blood sugar and reduced blood flow (a common problem caused by diabetes) affect the nerves of the skin, and one's sensation becomes altered. Diabetic patients become unable to sense trauma, and injuries can go unnoticed. Daily monitoring of the skin-particularly on the hands and feet-helps the diabetic patient find and care for small nicks and sores before they get out of control.

Fifteen percent of all diabetics will eventually form a painful, often debilitating ulceration-and no skin condition is more feared. That's because 70 to 90 percent of diabetics who face lower-leg amputation first dealt with an ulcer of the leg or foot, where the problem typically begins. These ulcers have two main causes: poor circulation; and trauma (due to diabetic neuropathy) combined with faulty wound healing.

Understanding one's options in ulcer care is extremely important. Effective treatment can help hasten healing, reduce discomfort, improve the prognosis, and in many cases help prevent future ulcers. Initial treatment for new, small ulcerations focuses on localized wound care, infection control, and maximizing blood How to the skin. If your physician seems unfamiliar with diabetic wound care, there is often a wound care nurse or department affiliated with the local hospital.

Moist Dressings. The use of antibiotic ointments and moist (hydrophilic) dressings is the first step. Lifting off a dry dressing can do more harm than good.

GHK Copper Peptides. GHK copper peptides-commonly used for skin rejuvenation but initially developed to help in wound care-improve fibroblast activity and collagen formation, and can help strengthen healing skin. Iamin gel consists of a patented hydrogel and GHK-copper-peptide formulation for the dressing and management of diabetic ulcers, as well as other types of wounds.

Growth Factors. Growth factors are essential for maximum wound healing, but there is a decrease in or absence of growth factors in diabetic ulcerations. Currently, the only growth factor-based therapy approved by the FDA for healing diabetic foot ulcerations is Regranex (becaplermin) gel, which aids wound closure and speeds wound healing.

Improving Circulation. Narrowing of major blood vessels in the legs needs to be addressed. Initial studies may include ultrasonography. Depending on the findings, angiography accompanied by angioplasty may help pop stenosed (blocked) vessels open.

The prescription medication Trental (pentoxifylline) helps improve blood flow through narrowed blood vessels and restores oxygenation, vital for healing as well as for preventing ulcerations.

Compression with medical hosiery helps reduce blood pooling in the lower legs due to vascular insufficiency. The swelling of the tissues surrounding tiny, already compromised blood vessels is minimized, which helps prevent them from being choked closed. This can improve overall oxygen levels and allow for elimination of toxins.

Other Treatments. Other treatments being investigated for the prevention and resolution of diabetic ulcer formation include topical bFGF (basic fibroblast growth factor), VEGF (vascular endothelial growth factor), and nitrous oxide.