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


Wounds. 2019;31(7):173-178. 

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Preexisting states, complications, therapies, and medications also may be factors for the development of xerosis. Preexisting states that may contribute to xerosis include end-stage renal disease, nutritional deficiency (especially zinc and essential fatty acids), thyroid disease, neurological disorders, human immunodeficiency virus, malignancy, radiation, antiandrogen medications, and diuretic therapy.[37] Unfortunately, the authors could not investigate these factors in the present retrospective study, and further studies are needed in the near future.

Another limitation of the present study is that diabetic neuropathy was assessed using the monofilament test and EMG/NCV test rather than the sudomotor test. There are limitations to sudomotor axon testing in a clinical setting, and electrophysiological tests usually are not recommended for establishing the diagnosis of diabetic neuropathy.[6,13,38] The diagnosis of diabetic neuropathy usually is based on physical examination and the EMG/NCV test.[6,13,39] Further studies might help specifically reveal the relationship between skin hydration and sudomotor nerve function. In addition, the present study did not divide patients into ulcer and nonulcer groups. Ulceration in diabetic foot disease could affect the microcirculation around the ulcerations. Further studies are required to clarify the influence of ulcerations on microcirculation.

There is insufficient research evidence to suggest skin hydration is influenced by nerve function. In particular, to the best of the authors' knowledge, no clinical study has been performed to assess the influence of peripheral nervous system on skin hydration. In addition, no clinical study has reported the influence of microcirculation on skin hydration.