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are one of the complications of diabetes
An excellent Atlas of these changes may be viewed at:-
"Photoessay: The Skin and Diabetes Mellitus by A Huntley"
The exact mechanism whereby diabetes causes these skin changes is unclear. But it should be noted that my clinical experience suggests that these skin changes are part of the "Insulin Resistance/ Metabolic Syndrome". This explains the clinical improvement which occurs when an insulin aware diet is implemented in some, the improvement only occurring in others when in dietary ketosis; both of these diets in association with exercise and achieving ideal weight help to overcome insulin resistance (IR) which may be missed by the physician because the blood sugar remains normal in the early years of IR.
THE FOLLOWING IS THE OPENING PARAGRAPH OF A USEFUL CHAPTER INHARRISONS ONLINE
Part 2: Cardinal Manifestations And Presentation Of Diseases
Section 9: Alterations In The Skin
Chapter 57: Skin Manifestations of Internal Disease
Authors: Jean L. Bolognia, Irwin M. Braverman
"It is now a generally accepted concept in medicine that the skin can show signs of internal disease. Therefore, in textbooks of medicine one finds a chapter describing in detail the major systemic disorders that can be identified by cutaneous signs. The underlying assumption of such a chapter is that the clinician has been able to identify the disorder in the patient and needs only to read about it in the textbook. In reality, concise differential diagnoses and the identification of these disorders are actually difficult for the nondermatologist because he or she is not well versed in the recognition of cutaneous lesions or their spectrum of presentations."