Onset of Diabetes Often Preceded by Appearance of Skin Disorders

Skin conditions are some of the most prevalent comorbid disorders that occur concurrently with diabetes. Depending on what region of the world you live in, if you have diabetes, you have anywhere between a 51.1 percent chance and a 97 percent chance of also having some form of skin condition.

The comorbidity of diabetes and skin conditions is well established and well documented, but the relationship between the two is not well understood. Does diabetes tend to cause skin conditions? Do skin conditions play a role in the development of diabetes? There are different schools of thought on the matter, but recent research may shed some light on how exactly the two are related.

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Many experts now believe that many skin disorders may be some of the first clinical signs of diabetes. Additionally, other benign conditions such as skin tags or rubeosis faciei may also predict the onset of diabetes.

“There are multiple specific cutaneous symptoms that should be recognized by dermatologists as suggestive of underlying diabetes,” says John Barbieri MD, MBA, a practicing dermatologist in Mason, Ohio, and a dermatology research fellow at the University of Pennsylvania in Philadelphia.

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The American Academy of Dermatology (AAD) has now identified conditions such as acanthosis nigricans, skin tags, diabetic dermopathy, rubeosis faciei, pruritus, granuloma an­nulare, necrobiosis lipoidica, scleroderma diabeti­corum, and bullosis diabeticorumas as possible precursors to diabetes. The AAD has therefore recommended that patients who have any of these skin conditions should receive glucose metabolism testing for diabetes.

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“Most predominantly, Acanthosis nigricans, characterized by dark, velvety thickening of the skin in the skin folds, often around the neck and armpits, is an important sign that could suggest insulin resistance or diabetes,” says Dr. Barbieri.

The PRIME study found that people who had acanthosis nigricans were almost twice as likely to have markers for type 2 diabetes, such as elevated fasting glucose, elevated insulin, and insulin resistance.

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Diabetic dermopathy, which consists of small, asymptomatic dull red to pink papules on the shins, has also been pathogenically linked to diabetes and diabetes-related problems such as retinopathy and peripheral neuropathy.

It is recommended that patients with one or more of these skin conditions or infections should be tested for diabetes and closely monitored for signs of the development of the condition. Proper management of skin conditions and diabetes can help maintain overall health and prevent many of the potential complications of diabetes.

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