Definition

Diabetic pruritus is a condition in which the skin itches in specific areas and occurs in people with diabetes. Itching in diabetic patients is commonly thought to be caused by poor blood circulation or diabetic neuropathy, a complication of diabetes mellitus that typically manifests as numbness in the feet or legs.

According to one study conducted in 2010, about 11.3% of diabetic patients complained of itching. According to another study published in 2021, around 36% of diabetic patients reported itching, resulting in a reduction in their quality of life. It is suspected that itching is caused by poor blood sugar control and is more common in diabetic patients with dry skin or diabetic polyneuropathy nerve disorders.

The patient's itching may be limited to specific areas, such as the lower (legs and feet), upper (arms and hands), torso, scalp, or buttocks. However, itching in diabetic pruritus can also be felt throughout the body.

Causes

Poor blood sugar control, which results in elevated sugar levels, is sometimes the underlying cause of itching in diabetic patients. High blood sugar levels can be caused by several conditions, including:

• Forgetting to take diabetes medication
• Consumption of foods that are high in carbohydrates
• Chronic stress
• Minimal physical activity
• Having an underlying infectious disease

High and uncontrolled sugar levels can damage nerve fibers in specific areas, resulting in a complication called diabetic neuropathy. Diabetic neuropathy symptoms include numbness, tingling, burning sensations, and itching, which are typically felt in the foot or leg. The nerve damage that occurs can also cause the immune system to release cytokine chemicals, which are proteins that help control the inflammatory response. Cytokines can irritate nerve fibers and cause itching.

Persistently high sugar levels can also impair blood circulation, especially in the legs. Damage to the lining of blood vessels causes narrowed arteries and restricted blood flow, a condition known as peripheral arterial disease. Itching can be caused by poor blood circulation, which causes the affected skin areas to dry out as the oil and water content evaporates. Some signs of dry skin include rough and scaly skin.

Diabetes can also cause several skin diseases that cause pain. Some skin diseases that can cause itching due to diabetes include:

• Bacterial infection
• Fungal infection
• Necrobiosis lipoidica diabeticorum, a rash that appears on the limbs 
• Eruptive xanthomatosis, a skin condition that causes small yellowish-red bumps on the body, which usually appear in people with high blood fat levels
• Granuloma annulare, an inflammatory skin condition characterized by soft, discolored spots and plaques

Risk factor

So far, poor blood sugar control has been identified as a risk factor for diabetic pruritus. In addition, aging and obesity are risk factors for itching in diabetic conditions. Additional risk factors for this condition include metabolic syndrome and chronic kidney disease. Stress and heat are said to be factors that aggravate itching.

Symptoms

The symptoms of diabetic pruritus include itching that interferes with daily activities. The severity of itching varies according to the patient's blood sugar control and the presence of any co-morbid skin conditions. Some people experience itching so severe that it makes it difficult to sleep or wake up.

Diagnosis

A doctor can diagnose diabetic pruritus based on a medical interview with the patient, a physical examination, and other supporting tests.

Medical Interview

A directed medical interview explores information about how the patient is currently feeling. Furthermore, the doctor may ask a variety of questions about the patient's current and previous illnesses, as well as their treatment history. Some of the information gathered by the doctor will be used in future physical examinations and supporting tests. Furthermore, the doctor may obtain information about the patient's diabetes mellitus as well as specific diabetes management medications.

Physical Examination

During the physical examination, the doctor will examine the itchy skin area to see if there are any skin abnormalities caused by scratching. For example, if there was an infection in the itchy skin area, or if other skin diseases developed as a result of the scratching.

Supporting Examination

The doctor will conduct laboratory tests and other examinations to support the diagnosis of diabetic pruritus, such as fasting blood sugar levels or intermittent blood sugar levels. Since this condition usually appears in patients with uncontrolled blood sugar levels, the doctor will determine whether or not the patient's current blood sugar is well controlled. In addition, some supporting examinations to assess skin abnormalities may be performed if necessary, especially if the doctor suspects that the itching is caused by a fungal or bacterial infection.

Management

The main treatment for diabetic pruritus is to control blood sugar levels, which can be done in several ways, such as:

• Taking diabetes medications
• Consumption of balanced nutritional food
• Doing exercise

Some other treatments that can help to relieve itching symptoms in cases of diabetic pruritus are:

• Apply moisturizer several times a day, especially after taking a shower
• Take a shower only twice a day, with lukewarm water
• Avoid skin care products with harsh chemicals
• Avoid wearing clothes that irritate the skin
• Use hypoallergenic detergents (the ingredients are less likely to cause allergies)
• Avoid applying lotion between toes

Complications

Complications that can arise in diabetic pruritus are usually secondary bacterial infections. The patient's habit of scratching the itchy skin area can cause wounds, which can allow bacteria to enter the skin. The existing bacterial infection can also aggravate the itching. Therefore, patients need to be educated not to scratch their itching skin.

Prevention

Prevention can start with controlling blood sugar levels through medication, diet, and exercise. However, several other steps can be taken to prevent diabetic pruritus, such as:

• Dry the skin thoroughly after showering and apply moisturizer to the skin
• Avoid scratching when itchy to reduce the risk of skin infection
• Use a humidifier or humidifier at home
• Check the skin area daily for cuts or scratches on the skin
• Wear appropriately sized shoes to avoid sores or the formation of blisters
• Limit exposure to water by taking shorter showers
• Avoid using harsh soaps that may dry out the skin
• Use cleansing gels or cleansing creams whenever possible

When to see a doctor?

Because this itchiness is typically a symptom of diabetes, you can consult your doctor to determine your sugar levels and organ function. The doctor will conduct a medical interview, physical examination, and other tests to determine the exact diagnosis and appropriate management.

Looking for more information about other diseases? Click here!