Diabetes and the Skin

Diabetes mellitus can cause alterations of skin homeostasis by both primary diabetes-induced changes of skin metabolism and by associated complications, such as vasculopathy and neuropathy resulting in various skin manifestations. Hyperglycemia-induced nonenzymatic glycation of structural and regulatory proteins plays a central role in the pathogenesis of diabetic complications. In addition, diabetic patients often exhibit altered keratinocyte functions due to the influence of insulin on keratinocyte proliferation, differentiation, and migration, resulting in impaired epidermal barrier function, delayed wound healing, and reduced stratum corneum hydration. This review describes the clinical aspects of the most common dermatologic skin manifestations that could be observed in patients with diabetes, which can be distinguished into specific cutaneous markers of diabetes and non-specific skin conditions associated with diabetes. The wide range of dermatologic conditions related to impaired glucose metabolism is important across multiple medical specialties to identify undiagnosed diabetes as early as possible and to better manage patients with known disease.