Skin characteristics of people with diabetes are different from people without diabetes, and this changing skin condition could be an important characteristic in relation to diabetic foot ulceration. However, due to ongoing discussions as to the nature of the changes and the lack of possibilities to use knowledge on skin characteristics in ulcer prevention or management treatment, knowledge on skin characteristics is not used in daily clinical practice.
A new paper by Ledoux and colleagues furthers our understanding of this complex topic. They investigated the feet of 4 deceased people with diabetes and 9 people without diabetes. Using cadavers obviously provides the advantage of actually being able to cut out pieces of the skin and perform detailed analyses under the microscope.
They looked at mechanical properties (such as an increased stiffness), as well as biochemical (such as changes in collagen) and histological (such as septal wall thickness) characteristics, and investigated the association between the three. With mechanical changes being linked to ulceration, if associations are found with potentially modifiable variables, this might lead to treatment to improve skin characteristics. Unfortunately, the correlations were weak and the model explained little of the variance found. The authors therefore have to conclude that other biochemical properties may better explain the mechanical changes.
Apart from the small number of patients included, another limitation of the study was the lack of information with regard to ulcer history in the feet of the people with diabetes. It might be more relevant to compare feet of people with diabetes without a history of ulceration, with feet of people with an ulcer. Cadavers from the second group could be obtained after amputation, which would be an interesting way to make use of legs after patients lose them.
With the weak correlations found, this study will not lead to clinical changes in the short-term. But it is hoped that this interesting and complex field will continue to be studied, to better our understanding of that core element: the skin on the foot of people at risk of foot ulcers.