Influence of Peripheral Neuropathy and Microangiopathy on Skin Hydration in the Feet of Patients With Diabetes Mellitus

Sik Namgoong, MD, PhD; Jong-Phil Yang, MD; Seung-Kyu Han, MD, PhD; Ye-Na Lee, MSc, RN, CWCN; Eun Sang Dhong, MD, PhD

Disclosures

Wounds. 2019;31(7):173-178. 

In This Article

Abstract and Introduction

Abstract

Introduction: Maintaining adequate skin hydration is crucial in the feet of patients with diabetes because xerotic skin may crack and develop fissures, thereby increasing vulnerability to ulceration and infection. The nervous system is considered the powerhouse for maintaining adequate skin hydration; however, no clinical study has assessed the effect of the nervous system on skin hydration. In addition, it is hypothesized that microcirculation may play an important role in maintaining adequate hydration in patients with diabetes.

Objective: This study aims to evaluate the influence of peripheral nerve function and microvascularity on skin hydration in the feet of patients with diabetes mellitus and compare the effects of these 2 functions on skin hydration.

Materials and Methods: This study included 266 patients with diabetic foot disease. Skin hydration was evaluated using corneometry and microvascularity by measuring the transcutaneous oximetry (TcpO2) of the foot. The Semmes-Weinstein 5.07/10-g monofilament test, electromyography, and nerve conduction velocity test were conducted to evaluate peripheral neuropathy. Patient data were divided into 3 subgroups according to test values, and statistical comparisons were performed using the linear-by-linear association trend and Pearson's chi-square tests.

Results: There was a significant (P < .001) correlation between skin hydration and TcpO2. However, there was no significant correlation between skin hydration and peripheral nerve function (P = .338).

Conclusions: The results of this study demonstrated that skin hydration in the feet of patients with diabetes mellitus mainly is influenced by microcirculation rather than peripheral nerve function.

Introduction

Xerosis, defined as abnormal dryness and scaling of the skin, is a common cutaneous disorder frequently observed in patients with diabetes.[1] Ultimately, the skin may crack and develop fissures, which are a potential gateway for the entry of bacteria, thereby increasing vulnerability to ulceration and infection.[2,3] Therefore, maintaining adequate skin hydration is crucial in patients with diabetes.

The nervous system is considered the powerhouse for the maintenance of adequate skin hydration.[4–10] Peripheral neuropathy, due to damage to small sympathetic nerves, is known to result in atrophy of sweat glands and decreased sudomotor response. This may affect the suppleness and flexibility of the skin and thus can lead to ulceration in patients with diabetic foot disease. Theoretically, peripheral nerve function should be associated with skin hydration level, because sweat glands are innervated by the sudomotor, postganglionic, unmyelinated cholinergic sympathetic C-fibers.[11,12] However, to the best of the authors' knowledge, no clinical study has assessed the influence of peripheral nerve function on skin hydration.

In addition, when the skin of patients with compromised microcirculation was examined, the authors found that the skin was extremely dry, rough, shiny, and desquamated. Based on these clinical findings, the authors also hypothesized that microvascular function might play a major role in maintaining adequate hydration of diabetic feet. Therefore, this study aims to evaluate the influence of the peripheral nervous system and microcirculation on skin hydration and to compare the influence of these 2 functions on skin hydration of diabetic feet.

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