There are two types of diabetes (Type 1 and Type 2). Both forms of the disease mean that the individual does not have the ability to properly control glucose (blood sugar). In Type 1 diabetes (formerly called juvenile diabetes), they do not have the insulin hormone to help them use sugar (hence the need to take insulin shots). In Type 2 diabetes (about 90 percent of diabetics) they can make insulin, but for many reasons their bodies cannot properly regulate blood sugar, and often it is too high. Type 2 diabetics usually take oral medications to help the body manage sugar levels. In Type 2 diabetics, the better news is that lifestyle changes such as increased exercise, maintaining a healthy weight and better dietary choices can and do make huge and meaningful health improvements to these people.
As many spa services focus on skin care, it is important to be aware of the differences in diabetic skin compared to people without diabetes. Diabetics can be more prone to skin care issues or problems than non-diabetics. Recent scientific research has started to point the finger to a set of compounds called "AGE" (Advanced Glycation Endproducts). The AGEs are a product of sugar binding with proteins, and (in the skin) they can crosslink skin collagen. Crosslinking collagen causes the skin to lose its suppleness and leads to wrinkles. Thus a person with diabetes may have distinct changes in their skin appearance or texture in addition to the effects of normal aging. Making our diabetic clients aware of their skin health through active self-monitoring should be an important part of our interaction with them.
Approximately 30 percent of diabetics experience a skin problem. Perhaps, the most common of these problems is dry skin. Dry skin and itching in most parts of the body is not healthy. In fact trying to keep the skin properly moisturized is not just for cosmetic reasons; it may even reduce the incidence of bacterial or fungal infections. Skin dryness has many potential causes, including simply over-washing with soap, over use of cosmetics, and exposure to harsh weather. The dry skin in diabetics may also be due to damaged nerves that no longer tell the body to sweat. When the body does not sweat, it does not encourage the production of natural oils which help the skin stay moist. The dryness and accompanying itching can start small cracks in the skin that could be the beginning of bacterial or fungal infections. Prevention of these conditions is definitely the preferred approach. The use of mild soaps is a very good place to start. After a shower (with preferably warm, but not hot water), the use of good quality moisturizers can definitely help reduce the incidence of infection and prevent problems. However, the use of moisturizers that only add water back to the skin may not be enough. The use of moisturizers that replace the natural oils of the skin should be encouraged. Adding such skin care products to their daily habits is very important. In addition, part of the cause of dry skin can also be due to poor circulation. So the need for a routine exercise program is very important. Exercise is not just for cardiac health but for healthy skin. You always look good from exercise benefits! Of course in all this, let us not forget to encourage keeping hydrated by drinking enough liquids! Water is widely available and usually free.
As we interact with our diabetic clients you may see a relatively common skin condition called diabetic dermopathy (DD). Dermopathy often looks like light brown, scaly patches. These patches may be oval or circular. Some people mistake them for age spots. This disorder most often occurs on the front of both legs. But the legs may not be affected to the same degree. The patches do not hurt, open up, or itch. By itself DD is not usually dangerous and there is no specific treatment. However the presence of DD is linked with other diabetic medical conditions such as nerve, kidney or retina damage. Another condition that aestheticians may observe in diabetic patients is acanthosis nigricans. This is a condition that results in the darkening and thickening of the skin in body folds and creases. Often areas of tan or brown skin, sometimes slightly raised, appear on the sides of the neck, the armpits, and groin. Acanthosis nigricans usually occurs in people who are very overweight, and is most common in Native Americans, African Americans and Hispanics. There is no cure for acanthosis nigricans, but losing weight may improve the condition. Acanthosis nigricans usually precedes diabetes.
Elevated blood sugar and poor blood circulation make diabetic clients prone to bacterial infections of the skin. Common infections include styes (infection of the eyelid glands), boils, folliculitis (infected hair roots), carbuncles, and even infections around the nails. Today, with proper skin and nail care, the risk of severe skin infections is lower but they do occur. During an infection, it is common for the affected skin or tissue to become inflamed, meaning that it becomes red, hot, swollen and painful to touch. Many different bacteria can cause these infections but perhaps the more common is Staphylococcus areus (staph). It is essential to have the client consult a doctor to help treat these conditions and prevent them from becoming worse or spreading to other parts of the body. The good skin hygiene practice described earlier will go a long way to have our diabetic clients minimize these complications.
Fungal infections are also conditions that frequently occur in diabetics. They are usually treated by doctors using prescription medications. The most common of these fungi are caused by the yeast known as Candida albicans. It can cause itchy red rashes surrounded by tiny blisters and scales. They often occur in the moist folds of the skin such as under the breasts, around nails, between fingers or toes, the groin and even under the armpits. To minimize infections in the foot area, skin between the toes should be dried carefully after a shower or bath and moisturizing lotions should never be applied to skin between the toes. The other fungus that is a common culprit is the Tinea which causes the so-called athletes foot or jock itch.
Very commonly, the scalp is an often overlooked area of skin since it is usually covered by hair. Diabetes is also frequently associated with thinning or loss of hair. Historically, accelerated hair loss may suggest that a patient has diabetes. Very often, many doctors do not pay much attention to hair loss because it is not life threatening. Regardless, loss of hair can be very upsetting to many patients. Again, the health of the scalp is very important in this condition. Like skin elsewhere in the body of diabetics, the scalp can also suffer from poor circulation. Poor circulation of course damages the health of the hair follicles. Assuming that the diabetic client can get sugar levels back to the normal range, scalp treatments that promote circulation may either slow or stop the process of hair loss.
Minimizing UV exposure while outdoors is definitely an important step to maintaining healthy skin. For those patients that enjoy the outdoors, we suggest that they stay in the shade during the peak hours of sunlight and if around water, use a waterproof sunscreen with a higher rating than SPF 15. Anyone in the skin care industry appreciates the importance of also treating the skin with moisturizers and other antioxidant repair creams, especially after sun exposure. It is always good to encourage them to apply sun screen to the tops of their feet, a place frequently overlooked and that burns easily. Diabetics can very easily burn their feet, especially if they have nerve damage and cannot easily feel pain. In the event that they get a sunburn, it is important to treat it as soon as possible. If the skin begins to peel, it is very important to use good lotions to minimize the skin cracking or opening, which would lead the way to an infection.
Diabetes is a disorder of how the body uses sugar, so almost every organ including the skin is affected by the condition. Aestheticians need to be attentive to the features of diabetic skin and carefully work with their clients to maintain skin health. Our diabetic clients would definitely benefit from our understanding and heightened awareness of their special needs.

Dr. Annette Tobia received her Ph.D. in molecular biology from New York University. She was an American Cancer Society Fellow at Rockefeller University in NYC in the department of biological chemistry. Dr. Tobia is the founder and president of MEG 21 with Supplamine and CEO of Dynamis Therapeutics, Inc. that was founded in 1997 based on a discovery made at Fox Chase Cancer Center. The scientists of Dynamis discovered chronic diseases and enzymes associated with aging. Dr. Tobia is part of several patent applications, which teach methods of treatment for inflammation and skin aging by inhibiting dermal 3DG.