context: If you have diabetes, it's important to be aware of potentially serious skin problems related to the disease and see your doctor before the problem gets out of control. In most cases, skin problems in diabetes can be managed with early diagnosis and treatment. Scleroderma diabeticorum: While rare, this skin problem affects people with type 2 diabetes, causing a thickening of the skin on the back of the neck and upper back. The treatment is to bring your blood sugar level under control. Lotions and moisturizers may help soften skin. Vitiligo: Vitiligo, a skin problem more commonly associated with type 1 diabetes than type 2 diabetes, affects skin coloration. With vitiligo, the special cells that make pigment (the substance that controls skin color) are destroyed, resulting in patches of discolored skin. Vitiligo often affects the chest and abdomen, but may be found on the face around the mouth, nostrils, and eyes. Current treatment options for vitiligo include topical steroids and micropigmentation (tattooing). If you have vitiligo, you should use sunscreen with an SPF of 30 or higher to prevent sunburn on the discolored skin. Acanthosis nigricans. This is a skin problem that results in the darkening and thickening of certain areas of the skin especially in the skin folds. The skin becomes tan or brown and is sometimes slightly raised and described as velvety. Most often the condition, which typically looks like small warts, appears on the sides or back of the neck, the armpits, under the breast, and groin. Occasionally the top of the knuckles will have a particularly unusual appearance. Acanthosis nigricans usually strikes people who are very overweight. While there is no cure for acanthosis nigricans, losing weight may improve the skin condition. Acanthosis nigricans usually precedes diabetes and is considered to be a marker for the disease. There are other health conditions that also are known to cause acanthosis of the skin and these include acromegaly and Cushing syndromes. It is thought that this health condition is a skin manifestation of insulin resistance. Skin problems linked to atherosclerosis: Atherosclerosis is a serious health condition caused by the narrowing of blood vessels from a thickening of the vessel walls due to plaque buildup. While atherosclerosis most often is associated with blood vessels in or near the heart, it can affect blood vessels throughout the body, including those that supply blood to the skin. When the blood vessels supplying the skin become narrow, changes occur to the skin due to a lack of oxygen, such as hair loss, thinning and shiny skin especially on the shins, thickened and discolored toenails, and cold skin. Because blood carries the white blood cells that help fight infection, legs and feet affected by atherosclerosis heal more slowly when they are injured. Necrobiosis lipoidica diabeticorum: Necrobiosis lipoidica diabeticorum ( NLD) is thought to be caused by changes in the collagen and fat content underneath the skin. The overlaying skin area becomes thinned and reddened. Most lesions are found on the lower parts of the legs and can ulcerate if subjected to trauma. Lesions have fairly well defined borders between them and normal skin. Sometimes, NLD is itchy and painful. As long as the sores do not break open, treatment is not necessary. If the sores do break open, see your doctor for medical treatment. Diabetic dermopathy: Also called shin spots, this skin condition develops as a result of changes to the blood vessels that supply the skin. Dermopathy appears as a shiny round or oval lesion of thin skin over the front lower parts of the lower legs. The patches do not hurt, although rarely they can be itchy or cause burning. Medical treatment generally is not necessary. Digital sclerosis: Digital sclerosis is a health condition in which the skin on your toes, fingers, and hands become thick, waxy, and tight. Stiffness of the finger joints also may occur. The medical treatment is to bring your blood sugar level under control. Lotions and moisturizers may help soften the skin. Eruptive xanthomatosis: This skin condition may occur when blood sugar levels are not well controlled and when triglycerides rise to extremely high levels. Severe resistance to insulin makes it difficult for the body to clear the fat from the blood. With extreme elevations in these blood fats people are at risk for pancreatitis, an inflammation of the pancreas. Eruptive xanthomas appear as firm, yellow, waxy pea-like bumps on the skin. The bumps -- which are surrounded by red halos and are itchy -- usually are found on the face and buttocks. They also can be seen on the back side of the arms and legs as well as in the creases of the extremities. Treatment for eruptive xanthomatosis consists of controlling the level of fats in your blood. The skin eruptions will resolve over a few weeks. Drugs that control different types of fats in the blood (lipid-lowering drugs) may also be needed. Rashes and bumps: Allergic reactions to foods, bug bites, and medicines can cause rashes, depressions, or bumps on the skin. It is especially important for people with diabetes to check for skin problems, such as rashes or bumps, in the areas where they inject their insulin. Diabetic blisters (bullosis diabeticorum): In rare cases, people with diabetes develop skin problems, such as blisters that resemble burn blisters. These blisters can occur on the fingers, hands, toes, feet, legs, or forearms. Diabetic blisters usually are painless and heal on their own. These skin problems often occur in people who have severe diabetes and diabetic neuropathy. Bringing your blood sugar level under control is the medical treatment for this health condition. Disseminated granuloma annulare: This skin condition causes sharply defined, ring or arc-shaped areas on the skin. These rashes most often occur on the fingers and ears, but they can occur on the chest and abdomen. The rash can be red, red-brown, or skin colored. Medical treatment usually is not required, but sometimes a topical steroid medication, such as hydrocortisone, may help. Bacterial infections: There are different kinds of bacterial infections commonly affecting the skin of those with diabetes. Skin infections with the bacteria known as Staphylococcus are more common and more serious in people with diabetes which is not under control. These bacteria can result in 'boils', an inflamed nodule from a hair follicle, which can occur in areas where hair follicles can be irritated. Other infections include styes, which are infections of the glands of the eyelids, and bacterial nail infections. Most bacterial infections require medical treatment with antibiotics in the form of pills and/or creams. Fungal infections : A yeast-like fungus called " Candida albicans" is responsible for many of the fungal infections causing skin problems in people with diabetes. Women in particular are prone to infection with this fungus in the vagina. Other commonly seen areas of infection include the corners of the mouth with what is known as "angular cheilitis," which feels like small cuts on the corners of the mouth. Fungus also can occur in between the toes and fingers and in the nails (onychomycosis). This fungus creates itchy, bright red rashes, often surrounded by tiny blisters and scales. These infections most often occur in warm, moist folds of the skin. Three common fungal infections are: jock itch (red, itchy area on the genitals and the inside of the thighs), athlete's foot (affects the skin between the toes), and ringworm (ring-shaped, scaly patches that can itch or blister and appear on the feet, groin, chest and abdomen, scalp, or nails). Medicines that kill the fungus are usually needed to treat these infections. A rare but potentially fatal fungal infection with Mucormycosis is seen in people with diabetes. The infection usually starts in the nasal cavities and can spread to the eyes and brain. Itching: Itching skin, also called pruritus, can have many causes, such as a yeast infection, dry skin, or poor blood flow. When itching is caused by poor blood flow, the lower legs and feet are most often affected. Using lotion can help to keep your skin soft and moist, and prevent itching due to dry skin. Keeping your diabetes under control is the most important factor in preventing these skin problems. Follow your health care provider's advice regarding nutrition, exercise, and medication. Keep your blood sugar level within the range recommended by your doctor. Proper skin care can also help reduce your risk of skin problems with diabetes.