“An estimated 11.3% of people with diabetes report dry, itchy skin.” During the chilly, windy, winter weather, there are several reasons why your skin may become extra dry and itchy. From lower outdoor humidity to heaters in your home, the air becomes dry and so can your skin. People with diabetes need to maintain proper winter skin care to avoid cracking, bleeding and other possible skin complications. Learn what you need to know about dry skin and diabetes skin care to avoid problems.
Reasons for Dry, Itchy Skin
- Uncontrolled diabetes: When blood sugars reach high numbers, and stay elevated for a while, your diabetes is considered “out of control”. One main problem with uncontrolled diabetes is dehydration. Your body is desperately trying to remove excess glucose, so it increases urination to pull out the sugar. Increased urination leads to dehydration and that can create dry, cracked skin.
- Neuropathy: Itching can be a symptom or precursor to neuropathy or nerve problems. Cytokines which are inflammatory substances, are formed in large numbers prior to neuropathy and may cause itching and dryness. Also, neuropathy can affect the functioning of sweat glands and decreased sweat causes more skin dryness.
- Liver failure: When the liver stops functioning effectively, bile products may deposit in the skin and cause severe dryness and itching.
- Renal failure: Kidney complications are common in diabetes and when renal failure occurs the excess urea which should be excreted in the urine increases and causes severe skin itching.
- Hypothyroidism and hormone changes: People with diabetes often also have hypothyroidism, low thyroid hormones which leads to dry, itchy skin. Your physician can easily check blood levels to make sure this is not affecting you. Menopause and female hormone imbalances may lead to skin changes and itching as well.
- Changes in collagen: Collagen is a protein present in the skin which, “supplies the matrix that sustains the body’s structure.” Collagen is responsible for skin strength and elasticity. Aging and high blood sugars lead to less collagen production and due to glycation, the collagen function is inhibited. This leads to slower healing and stiffening of tissues. When this occurs, the outer layer of epidermis, may shed or peel off. This layer protects you and acts like a barrier to bacteria and fungus. Collagen changes may damage blood vessels and reduce blood flow to the skin. Many people with diabetes have dry, shiny, thin skin on their shins due to collagen changes which leads to skin openings and possible infections.
- Cold air: With cold, winter air, the humidity drops which makes the air drier. Indoor and car heaters also dry skin out. Skin loses water through evaporation. Dry, itchy skin may lead to cracks on the feet, fingers, elbows and knees. This could lead to atopic dermatitis or irritated skin. People begin to itch, then scratch and the “winter itch cycle” begins. “The winter itch cycle” occurs more in the elderly and in those with diabetes and can result in a chronic situation. The skin eventually thickens and darkens. Scratching may lead to open skin areas, bleeding, irritation and an infection. Infections are problems for people with diabetes as they will raise blood sugars.
- Hot baths: Although a hot bath or shower may feel great, it is not advised for people with diabetes. Long, hot baths will strip away the natural oils in your skin and make it drier. Avoid soaking feet for the same reason. Soaking feet may lead to more fungus in the nails and Athlete’s foot.
- Medications: Certain medications increase your risk of dry, itchy skin. Water pills or diuretics used for high blood pressure may dehydrate you and lead to skin changes. Retinoids, like Retin A which treats aging skin and acne may cause problems with skin. Cholesterol drugs change skin texture and its ability to heal.
- Hand sanitizers: Overuse of hand sanitizers can lead to finger dryness and splitting of the skin. If possible, stick to regular, mild soap and tepid water for clean hands.
What Does Dry Skin Look Like?
The texture and color of your skin may change when you develop dry, itchy patches. Look for rashes, bumps, flakes, depressions, discolorations, patches, splotches and red plaques. You may locate tiny blisters which indicate a problem. Thin, shiny, hairless skin located on the shins may be especially dangerous to those with diabetes causing open patches of skin leading to infections.
What Can Be Done to Prevent Dry and Itchy Skin with Diabetes?
- Prevent problems: Learn to be proactive instead of reactive and avoid the problems entirely by controlling blood sugars. Get your A1C as close to 7% as possible unless otherwise directed by your physician. Blood pressure should be maintained at 130-140/80. Lipid levels should be monitored with LDLs below 70-100.
- Open wounds: Check feet, toes, hands and joint areas for any cuts, scrapes, reddened skin which can lead to a serious problem. Visit your MD if you have any questions or if you are unsure about what to do. Wash any open areas with warm, soapy water and keep clean and covered with a band-aid or gauze. Check to see which antibiotic is recommended.
- Bathing or showering: Use warm, tepid water and gentle soap when washing. Do not soak in the tub for long periods which strips the skins’ natural oils. Avoid perfumed, scented, dyes and strong soaps or bath salts. Consider taking oatmeal, colloidal baths for super dry, itchy skin. Never pick at your skin. Pat skin dry instead of rubbing and use a soft, fluffy towel which absorbs moisture easily. Moisturize immediately while the skin is still damp. Use a white, unscented ointment, cream or lotion depending on the dryness of your skin with the heavier, thicker product is used on very dry skin.
- Invest in a humidifier: A humidifier increases the humidity in your home or office during the dry, chilly winter months. More humidity means more moisture in the air.
- Stay hydrated: Drink plenty of calorie-free beverages especially plain water even in the cold months of winter.
- Protect hands and skin: Wear rubber or vinyl gloves when washing dishes or cleaning the house. Avoid harsh chemicals and look for more natural products. Use white vinegar, lemons, natural salt and baking soda as some recommended choices. Wear gloves outdoors to keep hands dry and warm.
- Sunscreen: Use sunscreen even in the winter months to protect your skin from wind, sun and cold temperatures. Make sure your face moisturizer has added sunscreen and use 30 SPF or higher. Lips become easily chapped in winter so protect them with lip balm that also contains sunscreen. Dry, cracked lips may increase your risk of cold sores. Keep in mind, the snow can reflect 80% of the sun’s ultra-violet rays.
- Stay warm: Make sure you are dressed properly both indoors and outdoors. Being too cold can compromise and aggravate circulation and skin problems. Wear gloves, a scarf, and a hat that covers your ears. Wear diabetic socks and water-proof shoes to keep your feet dry. Wear a combination of layers such as a t-shirt, a long sleeve shirt and a sweater so you can remove layers when too warm indoors.
- Avoid alcohol swabs when testing: Alcohol can dry out skin and cause cracks or fissures on fingers. Use gentle soap and water and dry hands carefully before testing your blood sugars.
Winter is the perfect time to focus on proper diabetes skin care. The chilly, winter months can play havoc with your skin but with some easy tips, you may avoid problems. Get dressed and get out and play!
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NOTE: Consult your Doctor first to make sure my recommendations fit your special health needs.
She is a member of the American Diabetes Association as well as the South Florida Association of Diabetes Educators. She worked with the education department of NBMC to help educate the hospital's in-patient nurses about diabetes. She practices a healthy lifestyle and has worked as a personal fitness trainer in the past.
She was one of the initiators of the North Broward Diabetes Center (NBMC) which started in 1990 and was one of the first American Diabetes Association (ADA) certified programs in Broward County, Florida for nearly two decades. Robbie has educated patients to care for themselves and has counseled them on healthy eating, heart disease, high lipids, use of glucometers, insulin and many other aspects of diabetes care. The NBMC Diabetes Center received the Valor Award from the American Diabetes Center for excellent care to their patients. Robbie has volunteered over the years as leader of many diabetes support groups.