Skin infections and abscesses are more common in patients with diabetes. This is probably due to the low grade persistent suppression of the immune system associated with high blood sugar levels coupled with dry itchy skin which allows infections to penetrate far more easily than normal skin.

Impetigo is a relatively common contagious infection primarily caused by the bacteria called Staphylococcus aureus and can be treated with flucloxacillin. It appears as a spreading crop of reddish lesions with honey coloured scabs.

Boils are commonly caused by the same organism and are infections of the hair follicle. They are painful red lumps with pus and if clustered together they are referred to as carbuncles. The resulting abscess can result in spread of infection to the rest of the body causing life threatening complications such as septicaemia.

Erythrasma is another skin infection more common in people with diabetes. It appears initially as a pink patch, usually in the skin folds and between the toes, but then it turns brown in colour and scaly in appearance. It is due to the bacteria Corynebacterium minutissimum and can be treated with erythromycin.

Diabetes also represents an increased risk of acquiring a variety of fungal based skin and nail conditions. The most common is onychomycosis of the toenails. This is also relatively common in the elderly population in general with the nail becoming thickened, discoloured and brittle. Pieces of nail may break off and the surrounding skin may become inflamed but it is usually painless and uncomplicated by other infections. The most common causes of this problem are the fungal dermatophytes and Candida and the mainstay of treatment is antifungal preparations. Curing this problem is however painstakingly slow because the infection is embedded within the nail and very difficult to eradicate. It may take up to a year of treatment and even then success is not guaranteed.

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