der-utilized. Skin care is frequently lacking or overlooked as part of patients’ DM skin treatment.3
To address these unmet needs, a review paper was developed to explore DM skin changes and possible benefits of appropriate cleanser and moisturizer use in DM skin treatment.
To address these unmet needs, a review paper was developed to explore DM skin changes and possible benefits of appropriate cleanser and moisturizer use in DM skin treatment.
METHODS
An expert panel of physicians involved in the care of patients with DM convened in Miami, FL, in March 2019, to deliberate about diabetic skin changes and the impact of cleanser and moisturizer use on skin health. For this purpose, selected information from literature searches coupled with expert opinions and experience of the panel were used. The literature review was conducted prior to the meeting; the results were presented and discussed during the meeting. The selected literature was deemed clinically relevant to DM skin changes and challenges in treating diabetic skin. Skin conditions that differ from DM skin changes, or those that would not necessarily benefit from cleanser and moisturizer use, are outside the scope of this review.
Diabetes Mellitus and Related Skin Changes
DM-related skin changes are a common complication seen in both type 1 and type 2 DM.2 Dermatologic conditions linked with DM vary in severity and while usually benign can in certain circumstances lead to major complications, including amputations.4,5 Cutaneous manifestations in DM may be classified into four categories: 1) Skin associated with DM (from strongest to weakest association include necrobiosis lipoidica, diabetic dermopathy, diabetic bullae, yellow skin, eruptive xanthomas, perforating disorders, acanthosis nigricans, oral leucoplakia, lichen planus); 2) Infections (bacterial, fungal); 3) Cutaneous manifestations of diabetic complications (microangiopathy, macroangiopathy, neuropathy); and 4) Skin reactions to diabetes treatment (ie, sulphonylurea rash or insulin lipohypertrophy).2 Additionally, hyperglycemia may lead to skin changes (Table 1), the mechanism of action is unclear and other factors are likely involved.2,6
In patients with DM, functional properties of the stratum cor- neum (SC) may be altered, impacting skin barrier function.4 A defective skin barrier predisposes the skin to water loss and to invasion by pathogens, which in turn may lead to dryness, hyperkeratosis and redness from inflammation.7 The status of the permeability and antimicrobial barrier of the skin in DM remains unknown.2 In-vivo impairment of the skin barrier was observed in type 2 DM mice models, which results from impairment of skin barrier homeostasis and decreases in epidermal prolifera- tion and epidermal lipid synthesis.8
In vivo and in vitro, pre-clinical studies show that, diabetes alters epidermis histology and suppresses proliferation of keratinocytes.9 Impaired keratinocyte homeostasis and epidermal barrier function, results in higher risk of chronic wounds and infection.10,11,13-15
Diabetes Mellitus and Related Skin Changes
DM-related skin changes are a common complication seen in both type 1 and type 2 DM.2 Dermatologic conditions linked with DM vary in severity and while usually benign can in certain circumstances lead to major complications, including amputations.4,5 Cutaneous manifestations in DM may be classified into four categories: 1) Skin associated with DM (from strongest to weakest association include necrobiosis lipoidica, diabetic dermopathy, diabetic bullae, yellow skin, eruptive xanthomas, perforating disorders, acanthosis nigricans, oral leucoplakia, lichen planus); 2) Infections (bacterial, fungal); 3) Cutaneous manifestations of diabetic complications (microangiopathy, macroangiopathy, neuropathy); and 4) Skin reactions to diabetes treatment (ie, sulphonylurea rash or insulin lipohypertrophy).2 Additionally, hyperglycemia may lead to skin changes (Table 1), the mechanism of action is unclear and other factors are likely involved.2,6
In patients with DM, functional properties of the stratum cor- neum (SC) may be altered, impacting skin barrier function.4 A defective skin barrier predisposes the skin to water loss and to invasion by pathogens, which in turn may lead to dryness, hyperkeratosis and redness from inflammation.7 The status of the permeability and antimicrobial barrier of the skin in DM remains unknown.2 In-vivo impairment of the skin barrier was observed in type 2 DM mice models, which results from impairment of skin barrier homeostasis and decreases in epidermal prolifera- tion and epidermal lipid synthesis.8
In vivo and in vitro, pre-clinical studies show that, diabetes alters epidermis histology and suppresses proliferation of keratinocytes.9 Impaired keratinocyte homeostasis and epidermal barrier function, results in higher risk of chronic wounds and infection.10,11,13-15