Cutaneous manifestations are common in metabolic disorders, such as DM and MetS. These conditions share a common etiopathogenesis. The associated skin findings may be the first clinical feature. An early diagnosis facilitates treatment and prevents long-term complications. 

Skin manifestations of DM include:

• Metabolic – anogenital pruritus, eruptive xanthomas, generalized pruritus, and yellow discoloration
• Infection – bacterial and fungal
• Vascular – macroangiopathy and microangiopathy
• Neuropathic – gangrene, mal perforans, neuropathic arthropathy (Charcot foot)
• Dermatologic complications – Abscesses, keloids, lipoatrophy, and pruritus
• Skin diseases – Acanthosis nigricans, acquired perforating dermatosis, diabetic bullae, diabetic dermaatrophy, granuloma annulare, necrobiosis lipoidica, sclederma diabeticorum, and vitiligo

Common bacterial infections precipitated due to diabetes are – carbuncles, ecthyma, erysipelas, folliculitis, furunculosis, impetigo, green nails, malignant external otitis, and necrotizing fasciitis. The usual presentations include – boils, abscesses, hair follicle infections, erythrasma, and intertrigo.

Diabetes patients are prone to fungal infections – candidal balnoposthitis, candidal paronychia, and dermatiphytosis.

The vascular involvements include microangiopathy atherosclerosis; and macroangiopathies – diabetic foot and erysipelas like erythema, pigmented purpuric dermatosis, and rubeosis face.

Complications of DM:

• Trophic Ulcers – neuropathic ulcers – anhidrosis and hyperhidrosis; neuropathic ulcers are circular, punched out in the middle of a callosity. Foot care is recommended. 
• Gangrene – is very common and is associated with skin discoloration. 

Dermatological complications associated with DM treatment are – abscesses, keloids, lipoatrophy, and pruritus.

Skin diseases that DM aggravates are – acanthosis nigricans, acquired perforating dermatosis, diabetic bullae, diabetic dermaatrophy, granuloma annulare, necrobiosis lipoidica, sclerederma diabeticorum, and vitiligo.

Associations in Longstanding DM:

• Dermopathy
• Bullae
• Pseudo acanthosis, acrochordons
• Slerederma diabeticorum
• Eruptive xanthoma
• Eruptive granuloma annulare
• Necrobiosis lipoidica
• Kyrle’s disease
• Lipodystrophies
• Yellow nails