Cellulitis or skin infection of the legs is very common among diabetics. Our skin is almost always covered with various kinds of bacteria that constitute the normal skin flora. These bacteria do not cause skin infection mainly because the outer layer of skin forms a protective barrier preventing the entry of these microbes. If these bacteria are somehow able to breach the barrier they are usually taken care of by our normally robust immune mechanisms. But this is not so in the case of diabetics. Diabetics suffer from nerve damage or neuropathy that affects their sweat glands (sudomotor). This results in decreased sweating and increased dryness of the skin.
Dry skin leads to pruritus and increases the tendency to scratch the leg skin surface with hands. This is more severe in patients with renal failure as skin irritants like urea collect on skin surface. If the nails of the hand are not trimmed or the patient scratches with a foreign body deeply enough the skin barrier is breached creating a portal of entry into the skin and underlying layers which progresses rapidly from cellulitis to life threatening infections.
The diabetic patient is more vulnerable because of the weakened immune system. It is important that the patient take care of the nails of his hands as well as that of his feet and measures be taken to maintain lower limb hygiene and hydration to prevent self induced trauma (scratching).
Take home message (THM): The nails of the patient hands and foot have be trimmed and hygiene maintained.