Diabetes and Skin Health: A Clinical Primer for Endocrinology Practices
Most clinicians who care for patients with diabetes have seen it: persistent itching with no clear rash, recurrent intertrigo, slow-healing wounds, injection sites that never quite look right.
These findings are common, familiar—and often managed reactively.
What’s easy to miss is that about one in three patients with diabetes develops a cutaneous manifestation at some point, and in some cases, skin changes appear before diabetes is formally diagnosed. For endocrinology practices, that makes the skin less of a side note and more of an early signal.
Why the Skin Changes in Diabetes
Diabetes alters skin biology in predictable ways.
Chronic hyperglycemia drives inflammation and oxidative stress, changes collagen structure, impairs microvascular flow, and disrupts the epidermal barrier. Over time, the skin becomes:
Drier and less elastic
Slower to heal
More vulnerable to infection
Less tolerant of irritation or friction
In type 2 diabetes, reduced skin lipids and antimicrobial defenses further weaken barrier function. The result is not a single “diabetic rash,” but a pattern of skin that struggles to maintain normal structure and defense.
What This Looks Like in Practice
Some diabetes-associated skin conditions are well recognized:
Acanthosis nigricans in insulin resistance
Diabetic dermopathy on the shins
Foot ulcers in long-standing disease
Others are less specific but more frequent:
Chronic xerosis and pruritus
Recurrent fungal or bacterial infections
Injection-site irritation or lipohypertrophy
Slow or incomplete wound healing
Certain findings—such as eruptive xanthomas—may even signal broader metabolic or cardiovascular risk rather than a primary skin disorder.
Individually, these issues may seem minor. Collectively, they reflect disease burden.
Why This Matters Beyond the Skin
Some diabetes-related skin findings are not just skin problems—they reflect what’s happening systemically. Diabetic dermopathy, for example, is frequently seen in patients who also have retinopathy, nephropathy, or neuropathy and should raise concern for underlying microvascular disease. Other findings, such as necrobiosis lipoidica, scleredema, or eruptive xanthomas, tend to appear in patients with higher cardiometabolic risk. Paying attention to these patterns turns a quick skin check into a simple way to identify patients who may need closer monitoring.
Skin complications influence diabetes care in ways that are easy to underestimate.
Patients with painful pruritus or recurrent infections often disengage from care. Injection-site problems can alter insulin absorption and contribute to glycemic variability. Poor wound healing increases healthcare utilization and delays recovery.
Many patients attempt to manage these issues on their own with over-the-counter products that are poorly matched to diabetic skin physiology, sometimes worsening irritation or barrier damage.
A Missed Opportunity in Routine Care
Most endocrine visits are necessarily focused on labs, medications, and targets. There is rarely time for structured skin assessment or anticipatory guidance.
As a result:
Skin findings are addressed late
Referrals occur after complications develop
Patients fill the gap with non-clinical advice
Yet many diabetes-related skin issues can be stabilized early with basic guidance on barrier support, injection-site care, and when to escalate concerns.
A More Integrated Approach
Addressing skin health in diabetes does not require endocrinologists to become dermatologists.
It does require recognizing skin changes as part of chronic disease expression and responding earlier, not later.
Brief screening questions, basic education, and coordinated support—particularly for medication- and device-related skin effects—can reduce downstream complications and improve patient experience.
Pharmacists and other team-based clinicians are well positioned to support this work by monitoring treatment-related skin effects and reinforcing provider plans over time.
Closing Thought
Skin findings in diabetes are common, clinically meaningful, and often visible long before complications escalate.
When viewed as part of the broader metabolic picture rather than an isolated concern, they offer an opportunity for earlier intervention—and better continuity of care. The infrastructure to support that integration is what's often missing.
