Because diabetes mellitus is a metabolic disorder characterized by disturbances in the traffic of metabolic fuels, it is associated with long-term multi-system degenerative disorders. These disorders involve the cardiovascular and nervous system, eyes, kidneys– and even the skin. This is not surprising since the skin is an actively metabolizing tissue, dependent on circulating fuels for biosynthetic activity, especially on the lower extremities. Bacterial and fungal infections of the skin are often associated with Diabetes. Prevention of such infections requires meticulous care of the feet. A program of foot care, therefore, should be a part of every diabetic regimen. This includes the regular services of a podiatrist; shoes that fit well, to prevent pressure points; washing the feet twice a day with tepid water, followed by thorough drying and the use of emollients; and prompt attention to foot wounds and blisters. Eighty-seven percent of the diabetic population is diagnosed with lower extremity dry skin– a risk factor in diabetes that can lead to secondary bacterial and/or fungal infections. It is not clear why this is true– whether it is because the diabetic patient is more susceptible to infections or less able to deal with an infection once it is established. These secondary infections may progress to ulcerations and may ultimately lead to amputation. Diabetic patients are also more prone to develop dry skin secondary to involvement of the nervous system that controls sweating. Their feet may exhibit hyperkeratosis and calluses, which are often painful and may crack and develop deep fissures. The exfoliation of excess layers of skin, therefore, before they have built up into painful calluses should also be a part of the daily foot care regimen. Dry Skin Preventative intervention studies have demonstrated a reduction in lower extremity complications when patients routinely lubricated their feet. Feet and lower legs, therefore, should be moisturized at least twice daily. Itching should also be controlled, to prevent scratching that can lead to hard-to-heal wounds and infection. Hyperkeratosis and Calluses Meticulous care of hyperkeratotic areas and calluses is vital. Careful exfoliation with salicylic acid or alpha hydroxy acids under physician supervision may be recommended. What they are and how they work It is said that Cleopatra used the debris at the bottom of a wine barrel– tartaric acid– to massage her face and keep it smooth. Today, she would use instead any of the numerous facial preparations that contain alpha hydroxy acids (AHA) to help smooth and refine the texture of the skin. Alpha hydroxy acids represent a group of chemicals in which the hydroxy group is in the alpha position. Members of this group include glycolic, lactic, citric, malic, mandelic and tartaric acids. Glycolic acid is derived from sugar cane, lactic acid from fermented milk, citric acid from citrus fruits, malic acid from unripened apples, mandelic acid from the extract of bitter almonds and tartaric acid from fermented grapes. Glycolic acid is the most popular of the alpha hydroxy acids. All of the acids are now produced synthetically for cosmetic use and are widely used in anti-wrinkle and dry skin care products. AHA’s have become popular because they have been clinically proven to provide a keratolytic effect on the skin. Through a chemical process, these acids accelerate the softening, dissolving or peeling of the outer layer of the skin. What is left is a new, younger, healthier layer of skin. A secondary benefit of AHA’s is the moisturizing effect they have on the skin. They help to maintain the skin’s capability to hold moisture. The skin feels softer and smoother, less rough and cracked. How AHA’s are Used in Diabetes Besides emollients and moisturizers, many doctors prescribe and recommend products containing AHA’s for their diabetic patients. Eucerin Plus Alpha Hydroxy Lotion is such a moisturizer, with exfoliating properties in addition to its moisturizing effect. These products are especially effective when used for calluses. Due to the risk of skin irritation, such as burning or stinging, AHA products should be used under medical supervision. Eucerin is an ideal choice for diabetic patients because of its outstanding efficacy, plus its range of ultra-gentle and safe formulations. Choose your Eucerin: New! Eucerin® Itch-Relief Moisturizing Spray provides safe, effective relief of extra-dry skin associated with pruritus. Proven to provide relief within two minutes, this new spray can relieve itch and prevent the scratching that can lead to infection and serious skin problems in diabetics. Steroid-free, non-sensitizing and non-irritating, Eucerin Itch-Relief Moisturizing Spray is an ideal choice for these patients. And it increases skin moisture levels as well–to help keep itch from coming back. The unique spray application is convenient for hard to reach areas and there’s no need to rub the skin. Use Eucerin Original, Lotion or Creme, to maintain daily skin health. Eucerin is also exceptionally safe and non-irritating–hypoallergenic and non-comedogenic, too. Recommended for daily use to: • moisturize and maintain the day-to-day health of diabetic skin • prevent chafing, which can lead to infection and more serious problems • keep feet smooth, moist and healthy Eucerin Plus Intensive Repair Lotion or Creme is the daily moisturizer of choice when skin is extra-dry, flaky or callused. Contains a gentle alpha hydroxy acid for mild exfoliation of extra-dry skin. Yet it does not irritate like other alpha hydroxy treatments. Contains no fragrances or other irritating additives. And for cleansing, recommend Eucerin Gentle Hydrating Cleanser– an exceptionally gentle, non-soap liquid cleanser. The rich, foaming lather moisturizes as it removes dirt and grime, leaving skin feeling clean, with no sticky residue. Check our Products section for more information on the Eucerin products mentioned above, including their ingredients and formulations. Patient literature available on Diabetic Skin Care– order our diabetic skin care instructional brochure for your patients. Check here for information on upcoming diabetes’ healthcare meetings. American Association of Diabetes Educators American Diabetes Association Juvenile Diabetes Foundation
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