"While it is not possible to make any sort of diagnosis based on a magazine picture, I am able to make general comments on the appearance, treatment and prevention of diabetic ulcers," says Delpierre.
Who gets these ulcers?
Do all diabetics, young and old, type 1 and type 2, get foot ulcers?
"Diabetic ulcers are common among diabetics, with foot ulcers being more common than leg ulcers. The longer a person has had diabetes, the greater the chances of getting ulcers, making them more common in older people. But this does not mean that young people are exempt from getting these ulcers," according to Delpierre.
"Type 1 diabetics are often diagnosed in their early teens, which could mean that by the age of 30, they have been diabetic for fifteen years or more. This does, however, not mean that they will definitely suffer from ulcers.
"But there are some diabetics, whose blood sugar levels may be 12 or 13, which is very high, who never have any problems with ulcers. And then there are those people whose diabetes is well-controlled, and yet they have constant problems with ulcers. These things are not always predictable," Delpierre says.
Causes of diabetic ulcers
Poor circulation and neuropathy are most frequently the cause of ulcers in diabetics.
When there is poor blood flow, there is not a good exchange of nutrients and oxygen at a microvascular level. Blood does not flow quickly through the small vessels and blockages are caused more easily in the arteries.
Diabetes can also cause neuropathy, a disease of the nervous system, which can result in the loss of feeling in the feet and sometimes in the lower leg.
"It's not that diabetes or neuropathy causes ulcers as such, but that these conditions result in extremely poor healing of any skin injuries. Often diabetics will have an injury, such as a blister or a cut, and because they have no feeling in that region, they do not realise that they have been hurt, and continue walking on an injured foot or leg," according to Delpierre.
"But all these ulcers need an initial incident to start off the process, so diabetics are advised never to walk barefoot. The solution in many cases is just not to get an injury in the first place. They should also regularly examine their feet and lower legs for small injuries," says Delpierre. "There have been cases of people walking on huge blisters for days without knowing that there is anything wrong. Because of the poor healing rate in diabetics, this kind of injury can lead to amputations. A wound that is not healing is serious for a diabetic and needs immediate attention."
Other skin conditions common in diabetics
There are other skin conditions affecting diabetics, such as varicose eczema. Because of the high blood sugar levels, the skin breaks down in certain areas.
But many older people, who are not diabetic, also get ulcers, especially around the ankles. This is as a result of vascular problems that are not connected with diabetes in any way. So even if you are not diabetic, any wound that is not healing, needs professional attention straight away.
So whether the four ulcers on Halle Berry's leg are connected to her diabetic condition or not, it would be wise for her to have them checked out anyway. (Susan Erasmus, Health24, December 2006)