Skin infections are common in diabetic patients. They can even be the presenting feature of diabetes mellitus. A high index of suspicion in patients suffering from recurrent common skin infections, or with severe uncommon or rare infections, sometimes helps in detecting diabetes in a person previously not known to have this common condition. There can be many factors underlying increased susceptibility to skin infections in diabetics including poor microcirculation, hypohidrosis, peripheral vascular disease, peripheral neuropathy, and the decreased immune response seen in diabetics. Some of these factors may result in poor wound healing for these patients.

Decreased neutrophil chemotaxis and phagocytosis predisposes diabetic patients to an increased susceptibility of infections. The incidence of colonization as well as infections of the skin with bacteria such as Staphylococcus, Streptococcus, and yeast (Candida albicans) in patients with poor control of diabetes is increased. Dermatophyte infections are not more frequent in diabetic than in nondiabetic individuals. Some of the rare but serious and life-threatening infections of skin such as necrotizing fasciitis, malignant otitis externa, and mucormycosis are more common in diabetics and require special mention.

HISTORY

Before the advent of insulin and antibiotics, bacteria causing severe or extensive furuncles, carbuncles, ecthyma, cellulitis, and styes were frequent among diabetic patients. These infections are still commonly encountered among diabetic patients especially in developing countries where the lifelong management of underlying diabetes in many patients may not be optimum because of the cost involved or ignorance.