Introduction

The rise in high blood sugar levels is caused by diabetes -a chronic metabolic disorder that makes the body unable to produce insulin or use insulin efficiently. Globally, public health concerns about it are growing. One of the side effects of diabetes is skin problems. Skin problems have affected 80% of diabetic individuals which can affect the quality of their life in a negative way. Furthermore, there is a chance that these complications will raise rates of morbidity and mortality. For various reasons, diabetic individuals suffering from skin problems is normal to them due to elevations in blood sugar levels that impair immunity, making it more challenging for the body to fend off infections.¹

Boil 

What is a boil? 

A boil, also known as a furuncle, is a pimple that is filled with pus. A group of boils is known as a carbuncle. The little, red pimples begin to expand in size and become filled with pus and bacteria (Staphylococcus aureus), which is the main cause of boils in the skin. The bacterial infection of the hair follicle causes a lot of pain and can be seen anywhere in the body, though they most commonly appear on the face, armpits, neck, thighs, and buttocks.²

What causes boils?

Staphylococcus aureus is the main reason that boils occur, but other fungi and bacteria can contribute. The bacteria enters the skin via a cut or hair follicle hole in the skin where hair is supposed to grow and this triggers the immune system to react by sending white blood cells to fight the bacteria. This leads to pus being formed in the infected skin as white blood cells accumulate. Carbuncles occur when more than one hair follicle becomes infected.²

Although anyone can get a boil, there are a few things that can make it more likely. Among these risk factors are:

• Close association with an infected person with Staphylococcus infection
• Being overweight
• EczemaDiabetes, cancer, or a compromised immune system. 

Your body has a tougher time-fighting infection when you have certain disorders, such as the ones aforementioned²

Symptoms of boils

Several hours, or in some cases a day, is needed for it to form. It starts as a red lump that is sensitive and swollen. When the boil grows, it may fail to warm to the touch, and some changes may occur them over time, such as that it may:²

• Become painful
• Fill with pus
• Grow in size
• Have a white or yellow core, akin to a pimple
• Get crusty or "weep"
• Spread to more regions

Diabetes 

Diabetes is a chronic metabolic condition characterised by high blood glucose or blood sugar levels, which cause long-term damage to the heart, blood vessels, eyes, kidneys, and nerves. Type 2 diabetes, mainly affecting adults, is the most common and it occurs when the body cannot produce sufficient insulin. Also, over the last three decades, nations of all levels of income have seen a huge increase in the widespread of type 2 diabetes, especially those of a lower income

Type 1 diabetes is referred to as juvenile diabetes or insulin-dependent diabetes, and is a chronic disease in which the pancreas generates little to no insulin on its own. Diabetic individuals require expensive treatment such as insulin to live. By 2025, there is a goal set globally to stop the rise in diabetes and obesity.³

Approximately 422 million individuals globally suffer from diabetes, with the majority residing in low and middle-income nations. Over 1.5 million die yearly from diabetes and there has been a rise in the number of cases and incidence of diabetes in the past few decades.³

Symptoms of diabetes

Many symptoms experienced by diabetic individuals are common to both Type 1 and Type 2 diabetes, however, there are typically fewer symptoms experienced by Type 2 diabetics compared to Type 1 diabetics. It is important to pay attention to the symptoms, some of which are listed below, to prevent further complications.³

• The need to urinate often
• Frequently thirsty
• Frequently hungry
• Weight loss without trying to lose weight
• Fatigue
• Loss of vision 

The connection between boils and diabetes

Skin infections are more common in people with diabetes for a number of reasons. The immunity system is impaired due to the rise in the blood sugar levels which makes it more difficult for the body to fight off the infections. Diabetes can also damage nerves and this makes the person’s sense of heat, cold or pain not effective. Furthermore, this means that diabetic individuals cannot identify wounds or infections quickly.¹

Boils and carbuncles are a skin disease caused by the bacteria known as Staphylococcus aureus. Boils are found everywhere on the body but particularly in buttocks, face, neck and armpits the appear the most and are distinct, painful, pus filled, swollen, red pimples. Diabetic individuals are also more susceptible to some infections due to reduced blood flow to the skin and this makes the immune system weak.¹

Does high blood sugar levels promote bacterial growth?

Since glucose is a favourable carbon source for various bacteria,the virulence and proliferation of bacteria rise due to hyperglycemia. Certain bacterial virulence mechanisms, such as tissue adhesion and biofilm development,are known to contribute to infection persistence which is facilitated by hyperglycemia.⁴

How does diabetes affect the immune system? 

The elimination of microbes is done by white blood cells (WBCs). However, hyperglycaemia, caused by diabetes, weakens the immune system which prevents WBCs from travelling to the infection region.The buildup of microbes in the blood vessels leads to less blood flow in the infected regions, making it worse for the immune system to fight the infections and heal.⁵

Vaccination is recommended for diabetic individuals against Pneumococcal disease and influenza (flu) as they make the symptoms of diabetes worse by increasing the blood sugar levels. Furthermore, diabetic individuals are at risk of getting infected by rare infections via gram -negative bacteria, fungi or chronic foot infections if their blood sugar levels are high.⁵  

There is huge chance to get foot ulcers by the insufficient blood flow in the feet and a nerve damage (neuropathy).⁵

Risk factors for skin complications 

Diabetes-related skin problems have a complicated and multifaceted aetiology. This is due to the altered collagen synthesis, reduced immunity, and changes in microvascular and macrovascular circulation. Poor glycaemic control, the length of diabetes, neuropathy, peripheral vascular disease, obesity, and smoking are risk factors for skin problems in diabetes. Corticosteroids (steroids) can also cause skin issues in diabetic individuals. Effective prevention and management strategies for skin problems in diabetes require a thorough understanding of the epidemiology, pathophysiology, and risk factors associated with these complications.¹

Prevention of boils 

Boils are sometimes unavoidable, particularly in those with compromised immune systems. However, you may be able to prevent staph infections by doing the following steps:^6,7

• Avoid sharing your personal items
• Covering wound areas
• Use mild soap when washing your hands regularly
• Drink plenty of water
• Applying free-scent moisturisers after showering
• For dry heels, use creams containing 10% to 25% of urea before going to bed

Treatment options for boils 

Don’t pinch or prickle a boil with a sharp object to release the pus as this will spread the infection further to other regions of your skin.²

Over time the boil will disappear by itself and in some situations a doctor is needed to remove the boil by cutting into your skin to get rid of the pus. Your skin will heal after the pus dries out, and in some cases a doctor will prescribe antibiotics if it is serious.²

The following methods are useful if you have a boil:²

• Always use a clean towel when cleaning your body 
• Pat the infected area with a warm, damp towel to speed up recover and relieve the pain
• Seek a doctor if you have the following problems:
  • Boil appearing on your face 
  • Notice fever or other related symptoms
  • If you are diabetic person or have autoimmune diseases such as lupus

Summary

Diabetes is a chronic disease that causes high blood sugar levels which weakens the immune system and makes infections more common. Up to 80% of diabetics experience skin issues, including painful boils caused by “Staphylococcus aureus”. These pus-filled bumps often appear on the face, neck, armpits,  thighs, and buttocks. High blood sugar impairs wound healing and increases bacterial growth.  Managing diabetes effectively is crucial to reducing these complications. This article discussed various methods that can be used for prevention and treatment of boils.