Skin conditions in diabetics

Bacterial infections

People with diabetes are more vulnerable to infection as a result of atherosclerosis, sensory neuropathy, hyperglycaemia and an impaired immune system, and tend to develop skin and urinary infections. Staphylococcus aureus or haemolytic streptococci are frequent invaders. Such infections in patients, especially if recurrent, may be associated with diabetes. This elderly man presented with recurrent boils. He was aware that recently he had been thirstier, urinating more frequently and losing weight. Urine and blood tests confirmed the diagnosis, and management was discussed. Individual boils were warm bathed and drained if necessary. As the problem was recurrent, a nasal swab confirmed the presence of S aureus. An antiseptic soap was recommended and a cream of chlorhexidine and neomycin was applied to the nostrils four times daily for 10 days to clear the carrier state. Severe infections require a seven-day course of a penicillin-based antibiotic such as flucloxacillin.