Keep the Legs You Stand On by Dr. Mark Hinkes
Dry skin is a condition that should be taken seriously by patients with diabetes. An examination by a physician will assure the skin condition will be appropriately diagnosed and treated. Unfortunately, most people do not know the difference between dry skin and infected or diseased skin.
While there are various medical reasons for dry skin, at the top of the list we should consider autonomic neuropathy. This malfunction of the nervous system is considered to be a variant of diabetic peripheral neuropathy where the nerves that innervate the glands that secrete oil and sweat fail to function. The results are dry flaky skin that seems to affect the entire leg can be very itchy and therefore dangerous. Repeatedly scratching this dry skin can lead to an ulcer on the leg. Without realizing that some skin infections can also be fungal (such a tine a infection or athlete's foot), or bacterial many people do not seek medical treatment. Thinking they have dry skin, they try to treat it themselves. They may apply over-the-counter moisturizing lotion, petroleum jelly, or baby oil. I have spoken with patients who have done this exact treatment for years but the affected patch never seemed to go away. More than likely they are trying to cure a pathological mold, fungal, or yeast infection known as tinea pedis or athlete's foot. The bad news is that this type of infection can be spread to other parts of the body or to other people. I normally give patients a surgical scrub brush to use with antibacterial soap and instructions to vigorously scrub their feet to get all the dead skin off, rinse and dry them well, and apply a topical anti-fungal powder or cream.
Another reason for dry, itching skin is venous insufficiency where the veins fail to function correctly and fluid collects in the legs. This problem leads to venous stasis dermatitis, where the skin of the legs can become discolored and itchy. Scratching this type of dry skin can cause a venous ulcer. In advanced cases, a rust to orange-brown discoloration can be seen in the skin. This change in the pigmentation of the skin is the result of hemosidirin or iron from the pigment in the red cells depositing in the skin. An ulcer should be seen as a wildly waving red flag that gets your attention, particularly if you have diabetes.
If it turns out that your problem is indeed dry skin, one treatment I use is an emollient lotion containing urea. Urea has the unique ability to moisturize dry skin by drawing moisture into the cell structure in the top layer of the skin. It is available in several strengths and is one of the best products for this condition. If you can't reach your feet, maybe you can recruit a family member or friend to help you apply lotion. Hydrating the skin is one behavior that actually helps to prevent ulcers and amputations.
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As I mentioned in an earlier post, one of the benefits that made it cost-effective for me to go with the real healthcare (HSA) plan rather than the phony (HRA) plan is that my company is now covering "preventative" medicines at $0 copay. The formulary for these, as stated by CVS/Caremark (my pharmacy benefits provider), covers all test strips, lancets, and control solutions. I dutifully get my doctor to write up prescriptions for all of my testing needs, submit...