What is the correlation between eczema and diabetes?

Eczema and Diabetes: A Bidirectional Relationship

Patients with eczema (atopic dermatitis) demonstrate impaired glucose tolerance and may have increased risk for developing type 2 diabetes, while diabetic patients experience significantly higher rates of eczema and other skin complications, particularly device-related contact dermatitis. 1, 2

The Evidence for Correlation

Eczema Patients and Diabetes Risk

• Patients with eczema show impaired glucose tolerance, with glucose disappearance rates of 1.69 mg%/min compared to 2.92 mg%/min in controls, indicating metabolic dysfunction even in the absence of diagnosed diabetes 2

• The relationship between atopic dermatitis and diabetes mellitus is complex and bidirectional, influenced by genetic factors, environmental triggers, systemic inflammation (particularly cytokines), epidermal barrier dysfunction, and medications used to treat AD 1

• While some studies demonstrate increased diabetes risk in AD patients, the evidence is inconsistent, with a few studies showing lower diabetes prevalence in certain AD populations 1

Diabetic Patients and Eczema Risk

• Approximately 34% of diabetic patients develop onychomycosis (fungal nail infections), nearly three times the rate of non-diabetics, though this represents fungal rather than eczematous disease 3, 4

• Device-associated contact eczema is the most clinically significant dermatological complication in diabetic patients, affecting 14.2% of insulin pump users and 18.3% of continuous glucose monitor users 5

• In pediatric and young adult diabetic populations, skin affections occur in 91.8% of patients, with eczematous reactions to diabetes devices representing the most frequent complication 5

• Among adults with type 1 diabetes, 34-35% of device users currently have active skin lesions, including eczema, scars, and wounds directly attributable to continuous subcutaneous insulin infusion or glucose monitoring 6

Clinical Mechanisms Linking the Conditions

Shared Inflammatory Pathways

• Both conditions involve dysregulated immune responses and chronic inflammation, with cytokine profiles potentially contributing to metabolic dysfunction in eczema patients and skin barrier disruption in diabetics 1

• Epidermal dysfunction in atopic dermatitis may contribute to systemic metabolic changes, while hyperglycemia in diabetes impairs skin barrier function and wound healing 1

Diabetes-Specific Skin Vulnerability

• Diabetic patients have reduced peripheral circulation, sensory neuropathy, impaired wound healing, and autonomic neuropathy causing dry, cracking skin—all factors that increase susceptibility to eczematous reactions 3, 4

• The combination of impaired immunity and frequent device use creates ideal conditions for contact dermatitis development 5, 6

Practical Clinical Management

For Eczema Patients

• Screen patients with moderate-to-severe atopic dermatitis for diabetes using fasting blood glucose and/or hemoglobin A1C, as recommended for psoriasis patients with similar inflammatory burden 7

• Monitor for metabolic dysfunction even in the absence of overt diabetes symptoms, given the documented glucose intolerance in eczema populations 2

For Diabetic Patients

• Perform regular skin examinations as an integral part of diabetes consultations, recognizing that over 90% of young diabetic patients will develop some form of skin complication 5

• Implement a basic skin care program for all patients using diabetes devices, including lipid cream application, proper device removal techniques, and avoidance of routine disinfection 8

• This preventive approach reduces wound development by 71% (OR 0.29,95% CI 0.12-0.68) without increasing infection risk 8

• Establish interdisciplinary cooperation between endocrinology and dermatology for classification and treatment of device-associated eczema, which affects one in three adult device users 6

Common Pitfalls to Avoid

• Do not dismiss skin complaints in diabetic patients as merely cosmetic—device-associated eczema can lead to device discontinuation and suboptimal glycemic control 5, 6

• Do not assume all diabetic skin problems are infectious; eczematous reactions are more common than bacterial or fungal infections in device users 5

• Recognize that a history of atopy increases risk for device-associated dermatological complications in multivariate analysis, requiring heightened surveillance 6

• Understand that proper management of one condition can mitigate the other—controlling inflammation in eczema may improve metabolic parameters, while optimizing diabetes control supports skin barrier function 1