Here are some scary statistics: almost 40% of adults in the US have prediabetes, and over 37 million have diabetes. What's even more worrisome is that one in five people with diabetes isn't even aware they have it. When it comes to diabetes or insulin resistance, early detection and treatment are key to preventing future health complications like heart disease, strokes, kidney disease, or poor eye health.
In this article, I want to share the top 8 warning signs of diabetes and insulin resistance that can appear on your skin. If you notice these skin findings, it may be the first clue that you need to see your doctor and start making changes right away. And for those of you who already know you have diabetes, this is a good overview of skin complications to be aware of, since these skin findings can offer insight into how well you're controlling your blood sugar.
I am Dr. Leonid Kim, board-certified in Internal Medicine and Obesity Medicine, and I discuss the most up-to-date, evidence-based information on metabolic health, weight loss, and longevity. Let's get into it
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1. Shin Spots (Diabetic Dermopathy)
The first skin condition to watch out for is called shin spots, or diabetic dermopathy. It's the most common skin finding associated with diabetes, and it often looks like light brown, scaly patches that are oval or circular. You'll usually see them on your shins, and sometimes on your forearms or thighs. It's typically caused by damage to small blood vessels. These patches don't hurt or itch and often don't require treatment, but if you notice them, you should still get them checked out by your doctor to make sure you don't have diabetes or prediabetes.
2. Necrobiosis Lipoidica Diabeticorum
The next skin condition to be aware of is called necrobiosis lipoidica diabeticorum. The skin changes are somewhat similar to shin spots, but these spots are fewer, larger, and deeper. They often start as dull, reddish, raised areas or bumps that look like pimples, and as the condition progresses, they turn into patches of swollen, hard skin that appears yellow, reddish, or brown. Over time, these patches take on a shiny, porcelain-like appearance, sometimes with visible blood vessels, and they can become itchy and painful.
For reasons that aren't entirely clear, this condition is more prevalent in women. It doesn't require treatment unless it develops into an open sore. It's very important to monitor these patches, as open sores can lead to infections, and in rare cases, even a type of skin cancer called squamous cell carcinoma.
3. Acanthosis Nigricans
Another skin condition to watch for is darkened skin in the creases of your neck, armpits, or groin. These patches have a thickened, velvety texture and are known as acanthosis nigricans. This is usually a sign of insulin resistance, and the best treatment is reversing the underlying insulin resistance. For those who are overweight or have obesity, weight loss can be very helpful.
4. Bullosis Diabeticorum (Diabetic Blisters)
Next is a condition called bullous diabeticorum, or simply diabetic blisters. These blisters tend to form on the backs of the hands, feet, and forearms, and look like blisters that appear after a serious burn. But unlike burns, these are painless and don't have any redness around them. They usually heal on their own within two to three weeks. The main things to watch for are signs of infection and getting your blood glucose under control.
5. Granuloma Annulare
Next is a skin condition called granuloma annulare, a rash often seen on the fingers, ears, or torso. This rash looks like bumps and patches that are pink, red, or skin-colored, and the bumps may form sharply defined rings with raised borders. This condition often has a fairly prolonged course, but there are medications available that can help clear it up.
6. Eruptive Xanthomas
The next skin condition to be aware of is eruptive xanthomas, which present as clusters of firm, yellowish, pea-like bumps with a red halo. These bumps may be itchy and are often seen on the back of the hands, feet, arms, legs, and buttocks. This condition is usually a sign of poorly controlled diabetes or high triglyceride levels, and the bumps disappear with improved glucose control.
7. Acrochordons (Skin Tags)
Next is a very common condition seen in people with diabetes or insulin resistance: acrochordons, or skin tags. They look like small growths that hang from a stalk and are usually seen on the eyelids, neck, armpits, and groin. Not everyone with skin tags has diabetes, but some studies show that as many as three out of four patients presenting with skin tags also have diabetes.
8. Digital Sclerosis
The last skin condition to discuss is digital sclerosis, which presents as tight, thick, waxy skin on the backs of the hands. This can cause the finger joints to become stiff and difficult to move, and some people describe feeling pebbles in their fingertips. This skin thickening can also occur around the knees, ankles, and elbows. Treatment usually involves improved glucose control and, at times, physical therapy.
Conclusion
Your skin can offer some of the earliest visible clues to underlying diabetes or insulin resistance, often before other symptoms appear. From shin spots and acanthosis nigricans to skin tags and digital sclerosis, these changes are worth paying attention to, both for those unaware they may have diabetes and for those already managing the condition who want a window into how well their blood sugar is controlled. If you notice any of these changes in your skin, talk to your doctor to check for diabetes, prediabetes, or early insulin resistance. Early diagnosis and treatment remain the most effective way to prevent more serious complications down the road.
FAQ
What are the most common skin signs of diabetes?
The most common is diabetic dermopathy, or "shin spots," light brown, scaly patches usually found on the shins. Other common signs include acanthosis nigricans (darkened, velvety skin in body creases) and skin tags (acrochordons).
Can skin changes be an early warning sign of diabetes before diagnosis?
Yes. Since about one in five people with diabetes don't know they have it, skin findings like acanthosis nigricans, skin tags, or shin spots can sometimes be the first noticeable clue prompting someone to get tested.
Are these skin conditions dangerous on their own?
Most, like shin spots, granuloma annulare, and diabetic blisters, are not dangerous on their own and often resolve without treatment. However, some, like necrobiosis lipoidica diabeticorum, need monitoring, since open sores can lead to infection or, rarely, skin cancer.
Do skin tags always mean someone has diabetes?
No, not everyone with skin tags has diabetes. However, studies suggest a strong association, with as many as three out of four people who have skin tags also having diabetes.
How are these diabetes-related skin conditions treated?
Treatment generally focuses on improving blood glucose control, since many of these conditions improve or resolve once diabetes or insulin resistance is better managed. Some conditions, like acanthosis nigricans, also improve with weight loss, while others, like granuloma annulare, may need specific medications.
When should I see a doctor about a change in my skin?
If you notice any of these patterns, especially darkened skin in body creases, unusual rashes, blisters, or skin tags, it's worth talking to your doctor to rule out diabetes, prediabetes, or insulin resistance.