People with diabetes can sometimes develop blisters on their skin. These are called diabetic blisters, bullosis diabeticorum or diabetic bullae. Diabetic blisters are relatively rare, and reports of how often they occur vary. They usually appear in people whose blood sugar is poorly controlled. They are painless and tend to clear up on their own without treatment. In this article we look at the causes and symptoms of diabetic blisters and suggest some ways to treat and prevent those that do not clear up on their own or respond to other treatment.
Diabetes – causes of diabetic blisters
The exact cause of diabetic blisters is unclear, but several factors may contribute to their development. Diabetic blisters can be caused by:
Ill-fitting shoes
Poor blood circulation
Candida albicans, a fungal infection
Other injuries or irritation of the feet or hands
A 2009 study states that diabetic blisters occur in 0.5% of people with diabetes. Another, older study of people in India from 2003 puts the figure closer to 2%. However, some people with diabetes have a higher risk of developing blisters than others. These include:
People who do not control their blood sugar effectively (blood sugar is too high).
People with diabetic neuropathy – nerve damage caused by long-term high blood sugar.
People with peripheral artery disease.
People who are sensitive to ultraviolet (UV) rays.
Men, as they develop diabetic blisters twice as often as women.
Symptoms
Diabetic blisters usually develop in people whose diabetes has been poorly controlled for several years (uncontrolled or untreated diabetes). However, some people may find that blisters are the first symptom of developing diabetes or even prediabetes.Diabetic blisters are usually clear bumps that most often appear on the legs, calves and feet, as well as on the hands, palms and fingers. They can be:
- irregular in shape
- up to 6 inches (15 cm) in diameter
- a single blister or, more rarely, several blisters merging into one larger one
- filled with clear fluid
- itchy
The skin around diabetic blisters usually looks healthy. If the skin is red or swollen, see a doctor immediately.
Treatment of diabetic blisters
According to a 2015 review in the journal Clinical Diabetes, diabetic blisters often clear up on their own without treatment within 2–5 weeks. Treatment therefore focuses mainly on preventing infection. One of the main ways to prevent infection is to avoid puncturing or bursting the blisters. If diabetic blisters are particularly large, persistent, painful or hot, they can be treated with:- Saline compresses: these can help relieve itching and irritation.
- Bandaging: this can protect the blister and surrounding skin and prevent the blister from bursting or being punctured.
- Aspiration: during this procedure, the doctor drains the fluid from the blister while leaving the skin covering it intact, to reduce the risk of infection.
- Topical antibiotics or steroids: these can help in severe cases, but they are a last resort and are not needed for most diabetic blisters.
In addition to reducing the risk of infection, it is also advisable to see a doctor or dermatologist to rule out more serious skin conditions that can develop in people with diabetes. In some cases the doctor may take a biopsy (sample) of the diabetic blister.
Prevention
The most important step in preventing diabetic blisters is controlling your blood sugar. Taking your medication correctly, eating a healthy, balanced diet and leading a healthy lifestyle (exercise, physical activity) are the best ways to control blood glucose effectively. People with diabetes should also keep a close eye on their skin (especially their feet, as people with diabetes often develop diabetic foot) and look out for blisters and other skin problems. You can reduce your risk of diabetic blisters by taking a few steps:- Check your hands and palms, legs and feet regularly and thoroughly. Also take care of skin hygiene and moisturise your skin (for example with a cream or lotion for people with diabetes).
- Wear well-fitting shoes and avoid shoes that rub or irritate your skin.
- Always wear socks and shoes to avoid injuring your feet.
- Wear gloves when using tools that can cause blisters, such as scissors.
- Limit your skin's exposure to UV rays and use sun protection outdoors.
- Consult your doctor or podiatrist so that any other foot skin problems can be treated without delay.
When to see a doctor
People with diabetes who notice any skin changes, including diabetic blisters, should contact their doctor. Symptoms that require prompt attention and treatment include:
- swelling of the skin
- red or irritated skin around the lesion
- a hot feeling in the blister
- pain
- fever
Important
Diabetic blisters are rare and are more common in people with uncontrolled blood glucose than in others with diabetes. In most cases the blisters are painless and heal on their own within a few weeks. However, because blisters increase the risk of secondary infection, it is important to consult a doctor if diabetic blisters appear, especially if they are accompanied by other symptoms.
Steps that can help prevent diabetic blisters include checking your skin regularly and protecting it from injury and irritation. Most importantly, people with diabetes should manage their blood sugar effectively to prevent diabetic blisters and other complications.
For daily care of the skin on your feet we recommend Eubos Diabetic's Skin Care Foot & Leg Cream – developed for the dry, crack-prone skin on the feet and legs of people with diabetes.
Adapted from https://diabetesjournals.org/clinical
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