What Happens to Skin With Diabetes? A Complete Guide

Up to 70–80% of people with diabetes will have a skin problem at some point. Many are mild and treatable, but some are early warning signs of diabetes or serious complications. High blood sugar damages blood vessels and nerves, weakens the immune system, and dries out the skin. This can cause dryness, itching, infections, dark patches (acanthosis nigricans), slow-healing wounds, and specific diabetes-related conditions like diabetic dermopathy and necrobiosis lipoidica.

The good news: good blood sugar control + simple daily skin care + early treatment can prevent most severe problems.

How Diabetes Affects Your Skin

To understand what happens to skin with diabetes, it helps to look at what high blood sugar does inside the body:

• Blood vessels are damaged.
  Chronically high blood sugar injures small blood vessels (microangiopathy) that supply oxygen and nutrients to your skin. Poor circulation means skin becomes thinner, drier, and slower to heal.
• Nerves are damaged (diabetic neuropathy).
  Nerves help you feel pain, temperature, and pressure. When they’re damaged, you may not notice a cut, blister, or infection—especially on your feet—until it becomes serious.
• The immune system is weakened.
  High blood sugar makes it harder for white blood cells to fight bacteria and fungi, so infections are more likely and harder to clear.
• The skin barrier dries and cracks.
  Diabetes often leads to dehydration and reduced sweat and oil production. Dry, cracked skin lets germs in and irritates nerve endings, causing itching.

Put together, these changes make skin with diabetes more fragile, slower to heal, and more prone to infection and inflammation.

Early Skin Changes That Can Be a Warning Sign of Diabetes

Sometimes, skin changes are among the first clues that someone has diabetes or prediabetes.

1. Dark, velvety patches (Acanthosis Nigricans)

• What it looks like:
  Dark, thick, “velvety” patches in body folds—especially the back of the neck, armpits, groin, or under the breasts.
• What it means:
  Strongly associated with insulin resistance and higher risk of type 2 diabetes.
• What to do:
  Ask your doctor to check your blood sugar (fasting glucose, A1C) and discuss weight, diet, and exercise.

2. Itchy, dry skin (especially on the lower legs)

High blood sugar and poor circulation can cause dryness and itching, especially on the shins. Scratching can break the skin and lead to infection.

3. Frequent skin infections

• Bacterial: boils, styes, inflamed hair follicles, or red, warm, painful areas on the skin.
• Fungal: itchy, red rashes with a scaly border, often in skin folds; recurrent athlete’s foot or vaginal yeast infections.

If you don’t yet have a diabetes diagnosis and you notice one or more of these patterns, it’s worth getting screened.

Common Skin Problems When You Already Have Diabetes

Below is a quick overview; we’ll go into more detail after the table.

Category	Example Conditions	What You Might Notice
Dryness & itching	Xerosis, generalized itching	Flaky, rough, itchy skin, especially on legs
Infections	Bacterial (Staph), fungal (Candida)	Red, warm, painful areas; oozing; itchy rashes in folds
Diabetes-specific lesions	Diabetic dermopathy, necrobiosis lipoidica, diabetic bullae	Brown “shin spots”, yellowish plaques, sudden blisters
Circulation-related	Ulcers, gangrene	Non-healing sores, especially on feet; black or blue tissue
Nerve-related	Neuropathic ulcers	Painless sores on pressure points (bottom of feet)
Pigment/texture changes	Acanthosis nigricans, vitiligo, yellow skin or nails	Dark or white patches, thickened or waxy skin, nail changes

1. Dry, Itchy Skin (Xerosis)

• Why it happens:
  Reduced sweat and oil production, plus nerve and vessel damage, leads to very dry skin.
• Where:
  Common on shins, feet, and hands.
• Risks:
  Cracks act like small “open doors” for bacteria and fungi.

2. Bacterial Skin Infections

People with diabetes are more prone to:

• Boils (furuncles)
• Carbuncles (clusters of boils)
• Infected hair follicles (folliculitis)
• Infected cuts or insect bites

Signs to watch for:

• Redness, warmth, swelling
• Pain or tenderness
• Pus or yellow crust
• Sometimes fever

3. Fungal Infections (Yeast and Dermatophytes)

The most common fungal culprit is Candida, which loves warm, moist areas like:

• Groin
• Under the breasts
• Armpits
• Corners of the mouth
• Nail folds

Symptoms include:

• Itchy red rash
• Tiny blisters or scales
• Clear border, often ring-shaped (ringworm/“tinea”)
• Recurrent athlete’s foot or jock itch

4. Diabetic Dermopathy (“Shin Spots”)

• What it is:
  One of the most common diabetes-specific skin conditions.
• What it looks like:
  Light brown, slightly scaly patches, usually on the fronts of the shins. They’re often oval or round and not painful or itchy.
• Treatment:
  No specific treatment; they’re usually harmless. The focus is on blood sugar control and protecting the area from trauma.

5. Necrobiosis Lipoidica

• What it looks like:
  Yellow-brown, shiny plaques with a red border, again most often on the shins. Skin may look thin with visible blood vessels.
• What it means:
  Less common but strongly associated with diabetes; can ulcerate and become painful if injured.

6. Diabetic Bullae (Blisters)

• What happens:
  Sudden, painless blisters that resemble burn blisters, often on the hands, feet, legs, or forearms. They can be large.
• Who’s at risk:
  Typically adults with long-standing diabetes and significant neuropathy.
• Care:
  Must be protected from breaking and infection; always tell a doctor.

7. Thickened or Waxy Skin (Diabetic Stiff Skin)

• What you might notice:
  • Thick, tight skin on the backs of the hands, fingers, or upper back
  • Trouble straightening the fingers fully
• Why it matters:
  Indicates changes in connective tissue; can be associated with long-term diabetes and poor sugar control.

8. Skin Color Changes: Vitiligo and Yellowing

• Vitiligo:
  White, depigmented patches where the immune system attacks pigment-producing cells. More common in people with type 1 diabetes (autoimmune).
• Yellowish skin or nails:
  Can reflect changes in collagen and nail proteins from chronic high blood sugar, and may also be tied to fungal infections or circulation issues.

9. Slow-Healing Wounds and Foot Ulcers

This is one of the most serious skin-related complications.

• Why ulcers form:
  • Nerve damage → you don’t feel pressure, heat, or minor trauma.
  • Poor circulation → less blood flow for healing.
  • High blood sugar → germs grow more easily; immune cells work poorly.
• Where:
  Usually pressure points—bottom of the foot, heel, sides of toes.
• Risk:
  If not treated early, ulcers can become infected, spread to bone, and in severe cases lead to amputation.

What about silicone foam dressings?

In many diabetic foot and leg wounds, doctors or wound-care nurses may choose a silicone foam dressing. These soft, padded dressings are designed to absorb moderate wound fluid, protect the skin from friction and pressure, and reduce pain when dressings are changed. They are often used on ulcers or open areas that are clean, not heavily infected, and still need a moist but not overly wet environment to heal. If you don't know what is silicone foam dressing and how does it work? You can click here.

However, silicone foam dressings are not a one-size-fits-all solution. Very dry black scabs, severely infected wounds, or deep tunnel-like wounds usually need a different approach. Always ask your healthcare provider or wound-care nurse which type of dressing is right for your specific wound and how often it should be changed.

Who Is at Higher Risk of Skin Problems With Diabetes?

Anyone with diabetes can have skin issues, but risk increases if:

• Blood sugar is frequently high (A1C above target)
• You’ve had diabetes for many years
• You smoke (worsens circulation)
• You have neuropathy or known circulation problems
• You’re overweight or obese (more skin folds, more insulin resistance)
• You have other autoimmune diseases (e.g., thyroid disease, vitiligo)

When Skin Changes Are an Emergency

Call your doctor or seek urgent care/ER if you notice:

• A wound that is spreading, very painful, or smells bad
• Redness that is rapidly enlarging or streaking up the limb
• Black, blue, or gray skin (possible tissue death/gangrene)
• Fever, chills, or feeling very unwell with a skin infection

These can signal serious infections that may spread to deeper tissues or the bloodstream, especially in people with diabetes.

Daily Skin Care Tips If You Have Diabetes

Dermatology and diabetes organizations consistently emphasize that good everyday skin care is part of diabetes management, not a luxury.

1. Keep Blood Sugar As Close to Target As Possible

No cream can fully “fix” skin problems if blood sugar stays high. Good glucose control reduces infections, improves circulation, and helps skin heal.

2. Build a Simple Daily Routine

Morning & night:

• Use a gentle, fragrance-free cleanser instead of harsh soaps.
• Pat skin dry—don’t rub.
• Apply a rich, fragrance-free moisturizer to damp skin, especially:
  • Lower legs
  • Feet (top and bottom, but not between toes)
  • Hands

Dermatologists often recommend moisturizers with ingredients like ceramides, urea, or glycerin to strengthen the skin barrier in people with diabetes.

3. Protect Your Feet Every Day

• Check your feet daily for cuts, blisters, redness, calluses, or color changes. Use a mirror or ask for help if needed.
• Always wear well-fitting shoes and socks—never go barefoot, even at home.
• Get professional podiatry care for corns, calluses, and nail problems. Don’t cut them yourself.

When silicone foam dressings may be helpful

If your doctor has diagnosed a diabetic foot ulcer or another open wound on your leg or foot, you might hear them mention a silicone foam dressing. In general, these dressings are most often used when:

• The wound has mild to moderate drainage (not completely dry and not soaking through bandages constantly).
• The area is on a pressure point or friction area, such as the heel, ankle, or the bottom or side of the foot.
• The wound has been properly cleaned and assessed by a professional and there is no uncontrolled, deep infection.

Silicone foam dressings can help create a moist healing environment, cushion the wound, and protect the new tissue while you walk or wear shoes. They also tend to be gentler on the skin when they are removed, which is important for fragile diabetic skin.

Even so, the decision to use silicone foam — and which brand or shape — should always be made with your healthcare team. Do not start or change wound dressings on your own if you have diabetes, especially on your feet. An early review by a wound-care specialist can prevent small problems from turning into serious infections or even amputations.

4. Avoid Extra Drying and Trauma

• Limit very hot showers; warm water is safer for skin and nerves.
• Avoid space heaters or heating pads on feet or legs—you may not feel a burn.
• Use a humidifier in dry climates or during winter heating.

5. Take Infections Seriously

• Treat athlete’s foot, jock itch, and suspected yeast infections early with over-the-counter antifungals or as directed by your provider.
• See a doctor for any infection that doesn’t start improving within 48–72 hours.

How Your Dermatologist and Diabetes Team Can Help

Many guidelines stress that skin findings can be a window into how well diabetes is controlled and can even help detect complications early.

Consider asking your doctor or dermatologist:

• “Do any of these skin changes suggest my blood sugar or circulation needs closer attention?”
• “Should I see a podiatrist for a preventive foot exam?”
• “Which moisturizers or cleansers are best for my skin type and diabetes?”
• “Do I need blood tests or imaging for this wound or rash?”

For people with complex or severe skin issues, referral to a dermatologist familiar with diabetes can make a big difference.

FAQs About Skin and Diabetes

Is every rash a sign of diabetes?

No. Many rashes have nothing to do with blood sugar. However, recurrent infections, dark velvety patches, slow-healing sores, or multiple brown shin spots are more strongly associated with diabetes and should be evaluated.

Do people with type 1 and type 2 diabetes get different skin problems?

They share many issues (dryness, infections, ulcers). Some autoimmune-related conditions such as vitiligo and certain autoimmune rashes are seen more often in type 1 diabetes, while obesity-related acanthosis nigricans is more common in type 2.

Can skin problems be the first sign of diabetes?

Yes. Studies suggest roughly 3 out of 4 people with diabetes have a skin disorder at some point, and in some, the skin change appears before the diabetes diagnosis.

Will better blood sugar control make my skin go back to normal?

Some conditions (like acanthosis nigricans or infections) can improve a lot with weight management, better glucose control, and appropriate treatment. Others, like diabetic dermopathy, may leave permanent marks but usually become less active once diabetes is well controlled.

Key Takeaways

• Diabetes affects blood vessels, nerves, immune function, and skin moisture, making skin more vulnerable.
• Early warning signs can include dark velvety patches, dry itchy skin, and repeated infections.
• Long-term complications include non-healing ulcers, blisters, thickened or waxy skin, and pigment changes.
• Most severe problems are preventable with:
  • Good blood sugar control
  • Daily skin and foot care
  • Early treatment of any skin problem

If you live with diabetes, think of your skin as another vital sign. Noticing small changes early and acting on them can protect your health in a big way.