How diabetes affects the skin was the main topic of discussion at the second meeting of the Cayman Islands Diabetic Support Group recently. Health Minister Anthony Eden was the invited guest.
Dr. Kapoor |
Held at the Family Life Centre, attendees listened to an informative presentation by Consultant Dermatologist Dr. Sonia Kapoor.
In introducing her Power Point presentation, the dermatologist said that diabetes is one of the most prevalent conditions in Cayman.
She gave an indication of the many complications associated with the illness including: retinopathy (eyes), neuropathy (nerves) and vascular/veins and nephropathy (kidneys).
She remarked that skin conditions were often the first sign of diabetes or an individual’s predisposition to the illness.
The dermatologist advised that the skin can give early indicators of diabetes and even someone’s predisposition to the illness.
Early detection and heightened awareness of diabetes and skin issues, Dr. Kapoor said, could prevent lower limb amputation, blindness and heart disease.
The pivotal role played by the largest organ of the body in effective diabetes management was often overlooked by sufferers.
Dr. Kapoor added that the skin was almost the most vulnerable organ to both internal and external threats.
‘The skin is fragile and is often the first line of defense for keeping out harmful bacteria and viruses,’ she said.
Raising awareness of skin’s function in diabetes management, Dr. Kapoor said was critical in trying to stave off diabetes related complications in later life.
The doctor mentioned that high glucose levels of diabetics, who are not managing their illness well, can provide the right conditions for bacteria and fungus to thrive.
Dr. Kapoor discussed yeast infections including thrush which can thrive in moist areas such as under the armpits, the groin and in and around the mouth as well as between the digits.
She also showed images of bacterial infections including styes, infections of the hair follicles and carbuncles (deep infections of the skin and skin tissue). Staphylococcus was mentioned as the most common type of bacterial organism.
The dermatologist said that several skin complaints affecting diabetics can cause itching. The feet and ankles were areas most commonly affected by such discomfort caused by the yeast build up, dry skin and poor circulation.
Dry, scaly and rough skin, was most evident in elderly diabetics, she noted and could lead to cracks in the skin, which are themselves portals for fungus and infection.
Scratching, she remarked, only exacerbates the condition.
Vitiligo was another complaint, which though not exclusive to Type I diabetics was known to disproportionately affect sufferers. This condition causes skin discolouration and was most prevalent on the chest and abdomen, she advised.
Another skin condition, which can be symptomatic to diabetes, is Acanthosis Nigricans. Its symptoms include significant darkening and thickening of skin folds under the arms, neck, elbows or knees.
Another highly common indicator of diabetes, or a predisposition to it, was said to be crochordon – better known as skin tags. The small, benign growths are generally found around the neck, face and chest.
Found particularly among the obese and those who had sudden weight gains they can cause irritation if they rub against clothing such as at the collar.
Other skin complaints common among diabetics included skin taking on a shiny appearance, the thickening and discolouration of the toe nails and cold skin.
Dr. Kapoor advised that in diabetics skin complaints often healed slower, caused by reduced blood supply and slower circulation of oxygen associated with the illness.
‘Diabetics who are unable to manage their blood sugar levels properly are prone to getting non-healing wounds from even the smallest scratches,’ the dermatologist cautioned.
Daily inspection of the skin, especially around the feet, frequent changes of dressings and general attentiveness to wound care were also recommended. She also advised diabetics to schedule visits to podiatrists for professional foot care consultations.
‘In diabetics, serious skin lesions can result from even the littlest scratches or skin fissures,’ the dermatologist said.
Because of this, Dr. Kapoor strongly urged sufferers to wear broad-fitting footwear as narrow styles only decreased already poor blood circulation.
Further skin problems associated with poorly managed diabetes were also outlined. These included diabetic dermapathy (also known as skin spots), digital sclerosis (where the skin becomes thick, waxy in appearance and tight), and eruptive xanthomastosis (causing firm, yellow waxy bumps and is often mistaken for acne on the face or buttocks).
As well as explaining the symptoms and affects of each skin ailment in her Power Point presentation, Dr. Kapoor showed images, outlined preventative and mitigating measures and spoke of the long-term implications of leaving even moderate cuts unattended.
‘You don’t necessarily have to go to a dermatologist. You can go to who ever you feel comfortable with like your local family doctor or pharmacist.’
Foot infections, the most common type of infections in diabetics, were said to result from compromised vascular supply.
The dermatologist stated that foot infections – caused by local trauma or pressure on feet – were most likely to affect the less mobile.
In such cases, she said, the blood flow to the feet became sluggish due to poor circulation and in some cases caused itching and ulcers at the site.
Acute Ostseomyelilis – non-healing, untreated wounds which travel through the dermis, fat and muscle and eventually through bone – were also highlighted. Dr. Kapoor remarked that in the most extreme cases imputation and even death could occur through blood poisoning (septicemia).
The doctor cautioned badly managed blood glucose, which in some sufferers led to a loss of sensation. Lack of sensation could, she explained, easily lead to sufferers being unaware they had non-healing sores. Such persons were also at risk of unwittingly burning themselves.
Health Minister
The Health Minister, Anthony Eden fielded two questions during the meeting’s question and answer session. The enquiries concerned diabetes care within the health services authority, in view of the large numbers of diabetics in Cayman, and the current state of adequate health care coverage for sufferers.
Mr. Eden briefly outlined the work of the HSA’s dietician and said Superintendent of Pensions, Mervyn Connolly, would address the issue at a future meeting of the group.
FYI
The next Diabetes Support Group meeting will be at 5.30pm on Tuesday, 10 April in the Family Life Centre, off Walkers Road. The invited speaker, US-based Podiatrist Dr. Rothenburg, is also a certified diabetes educator and wound specialist.
For more information on the Cayman Diabetes Support Group contact [email protected] or phone 926-1053
Skincare tips
? Monitor blood glucose levels daily to keep them in check. Uncontrolled levels can cause dry skin and an inability to ward off infections.
? Visit a healthcare specialist for infections. If untreated they may worsen.
? Keep skin clean and dry. Use talcum powder and anti-chaffing/barrier creams in areas where friction occurs.
? Protect the skin by wearing gloves when using chemicals and detergents while cleaning.
? Avoid taking hot baths and showers. Do not use bubble baths which are astringent and consult a dermatologist for recommended brands.
? Don’t moisturize between the toes. This encourages fungus and bacteria to grow. Skin can become ulcerated.
? Avoid scratching as you risk opening skin up to infection.
? Treat minor cuts promptly with soap and water. Rubbing alcohol and iodine are too harsh.
? Consult a healthcare specialist immediately to treat major cuts/ burns.
? Check daily for sores and cuts and wear broad, flat shoes that are well fitting, restricting high heels to occasional wear.
? See a registered dermatologist or other healthcare specialists regarding skin problems.
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