Many of the complications of the diabetes are well studied but robust research 
documenting the cutaneous effects of the disease remains sparse. Various studies 
have suggested that the majority of patients with diabetes will suffer a skin 
disorder during the course of their disease and for some, the skin changes may 
even precede the diagnosis of diabetes. Cutaneous pathology of the diabetic foot 
and lower leg can arise as a result of the direct or indirect effects of 
diabetic complications. The most common manifestations include fungal and 
bacterial skin infection, nail disease and diabetic dermopathy. Other less 
commonly observed conditions include diabetic bullae, necrobiosis lipoidica 
diabeticorum (NLD), granuloma annulare and reddening of the soles. For many of 
the less common disorders, there is little in the way of effective treatment. 
However, much can be done in the clinical setting in the management of the more 
common manifestations such as bacterial and fungal infection. Fungal infection, 
in particular, although relatively inconspicuous, is a very common foot problem 
and if left untreated can threaten tissue viability in the diabetic foot leading 
to secondary bacterial infection and cellulitis. Management of fungal disease is 
often considered difficult due to high relapse and re-infection rates, although 
by introducing a combination of therapies including mechanical and 
pharmacological the success in treating this stubborn condition can be greatly 
improved.