Spot the Signs: How Diabetes Shows Up on Black Skin
Diabetes UK reports that 4.6 million people currently live with the condition in the UK, predicted to reach 5.2 million this year.
The Centre for Disease Control and Prevention in the USA reports that as of 2021, 38.4 million Americans had diabetes. In Africa, it’s estimated that 24 million people were living with diabetes in 2021.
In the UK, a new diabetes diagnosis is made every two minutes. Type 2 diabetes in particular disproportionately affects African, Caribbean and South Asian ethnicities, making these groups two to four times more likely to develop the condition than their White counterparts¹.
What is diabetes?
Diabetes is a condition where your blood contains too much glucose (sugar). In a healthy body, insulin regulates blood sugar. In diabetes, insufficient or ineffective insulin causes sugar to build up in the blood, preventing cells from using it for energy.
It’s reported by Diabetes UK that 4.6 million people currently live with the condition in the UK, predicted to reach 5.2 million this year. The Centre for Disease Control and Prevention in the USA reports that as of 2021 38.4 million Americans have diabetes. In Africa, it’s estimated that 24 million people were living with diabetes in 2021, predicted to increase by 129% to 55 million by 2045, according to the International Diabetes Federation.
“The symptoms to look out for are needing to wee a lot, increased thirst, extreme tiredness, unexplained weight loss, infections like thrush, slow healing of cuts and wounds, and blurred vision.”
Type 2 diabetes makes up 90% of cases, when the body is making too little insulin or insulin that is not functioning as it should. Black and brown people are at a greater risk of developing Type 2 diabetes at a younger age than other communities—starting from the age of 25 compared to over 40 in White populations. Type 1 diabetes accounts for 10% of cases and this is when the body cannot produce insulin.
High blood sugar levels can impact the nervous, immune and circulatory systems, causing damage across the whole body but the feet are disproportionately affected due to poor circulation and nerve damage. Other complications of diabetes include sight issues, kidney damage, gum disease, sexual difficulties, and an increased risk of heart attack and stroke.
How does diabetes impact the skin?
Visual cues on the skin can signal pre-diabetes, diabetes or the need to adjust your diabetes treatment. To provide expert insight, we sought the advice of Consultant Dermatologists Dr Derrick Phillips, Dr Emma Amoafo-Mensah, and Dr Mary Sommerlad.
Six common ways diabetes affects Black skin:
Poor wound healing and open wounds - Due to limited blood flow, wounds and bruises heal slower than usual and diabetic ulcers can occur on the feet.
Acanthosis Nigricans - This is one of the most common signs of Type 2 diabetes in Black individuals. Dr Amoafo-Mensah describes this condition as ‘dark, velvety skin changes usually behind the neck, in the armpit or groin. This often appears early and can be used as a warning sign before the full development of diabetes in many cases. If you notice these skin changes, see a doctor for tests and you may be able to make changes to your diet and lifestyle that can prevent diabetes before it has fully set in.’
Severe dryness (xerosis) - Diabetes disrupts nutrient supply to the skin, impacting the skin barrier and resulting in dehydration and persistent, extremely dry skin, which is often more pronounced in people with darker skin. This can cause the skin to crack, increasing susceptibility to infections. Dr Phillips adds, ‘Other common changes include thickening of the skin around the fingers, reducing dexterity and increased skin fragility.’
Skin tags - These small, flesh-coloured bumps hang off the skin and can appear anywhere exposed to frequent friction, such as the neck and underarms. According to Dr Emma, ‘Skin tags are very common and usually harmless growths on the skin, but occasionally, having many skin tags may be a sign of diabetes (NB: this is not the same as dermatosis papulosa nigra, which isn't usually associated with diabetes).’
Infections and itchiness - Diabetes makes you more susceptible to infection. Dr Phillips explains, ‘Skin infections are a common complication of diabetes and include yeast infections of skin folds. They appear as dark red to brown/black, weepy, malodorous [foul-smelling] areas beneath the breasts, below the abdominal apron, and in the groin.’ Dr Sommerlad adds, ‘In clinic, I see chronic fungal skin infections including Tinea pedis (Athlete’s foot), Onychomycosis (yellowed fungal nail) and Tinea Corporis (ringworm).’
Psoriasis - Although the exact cause is unclear, Type 2 diabetes has been linked to Psoriasis. Dr Mary remarks, ‘Psoriasis is more common in those with diabetes, and in those with skin of colour or Black skin, it presents as hyperpigmented, grey-scaled plaques rather than red plaques with a silver scale, which is typical in those with white skin.’
Caring for Black Skin
It goes without saying that before any skin consideration, actually managing diabetes should be the top priority. Dr Sommerlad advises ‘prioritise diabetes control through lifestyle changes—such as regular exercise, including both strength training and cardio, avoiding high-glycemic and ultra-processed foods—and with anti-diabetes medication as prescribed by your diabetes practitioner.’
Go low and slow
When it comes to your daily skincare routine, focus on barrier care, protection and hydration. Support the skin with key ingredients like ceramides, peptides and antioxidants (plus sunscreen, of course!) to bolster its defences and encourage healthy cell renewal.
Active ingredients such as exfoliating acids and retinoids can help to target concerns like uneven skin tone, texture and breakouts, but follow the low and slow rule - use at low strengths and take your skin to minimise the potential of any irritation.
Lactic acid or PHAs like gluconolactone are a great place to start. These acids not only exfoliate gently but also enhance hydration, making them ideal for skin prone to dryness. As for retinoids, choose milder and derivative type options such as hydroxypinacolone retinoate (HPR).
For oily, breakout-prone skin, azelaic acid is a worthy ingredient to include in your skin - its anti-inflammatory so great for acne and Rosacea, antibacterial and can help to fade dark marks and hyperpigmentation.
Foot Patrol
Keeping the skin, particularly on your feet, in good condition should also be top of mind for people with diabetes. Wearing socks and shoes made for neuropathy (nerve damage) can help maintain foot health and prevent skin issues. Dr Sommerlad adds, ‘Skin infections such as Tinea Pedis must be treated as soon as possible to limit the spread of infection.’
Nerve damage can prevent you from sensing skin damage, you need to be proactive so ‘check your skin regularly for cuts, changes in texture, or infections, especially on your feet.’ advises Dr Phillips.
STAY DRY
Wash with a mild, neutral soap and make sure that you dry yourself off properly, paying special attention to the spaces between your toes, under your arms, and anywhere else that water can hide to avoid infections. ‘A good skincare routine that involves cleansing and moisturising the skin is a good place to start. If you have any leg ulcers or sores, these should be cleaned daily, a thick moisturiser such as Aquaphor or CeraVe Healing Ointment, applied to the legs to maintain a healthy skin barrier, and dressings applied where needed,’ explains Dr Amoafo-Mensah.
Steer Clear
Hot Showers and Harsh Cleansing - Dr Phillips warns, ‘Avoid hot showers, as reduced skin sensation increases the risk of burns. Also, steer clear of harsh soaps, scrubs, or alcohol-based products, which can further dry or irritate the skin.’ Dr Amoafo-Mensah also recommends avoiding ‘perfumed soaps or intimate washes to help prevent thrush’
Aesthetic treatments - Since there is a greater risk of infection and slower wound healing, approach Botox, filler, microneedling, chemical peels, laser therapy, and microdermabrasion with caution. Always consult your doctor before proceeding and inform your practitioner of your diabetes during the consultation.
DIY Skincare - Dr Amoafo-Mensah advises, ‘It's important not to use any harsh products or take drastic methods to ‘fix’ your skin. Don't be tempted to try to remove skin tags at home or try to scrub the acanthosis nigricans off!’ If skin tags are bothering you, a dermatologist may be able to remove them safely in clinic.
Foot care - Avoid applying cream or talc between the toes as dampness can lead to infections, while dryness increases the risk of sores. For corns or verrucas, consult a podiatrist instead of using off-the-shelf tools like foot blades or medicated plasters which can burn the skin and cause ulcers.
Regardless of skin condition or its appearance, if you have any concerns about diabetes or displaying any symptoms, it is crucial you speak with your doctor immediately.