TEWL: A Promising Predictor for Diabetic Foot Ulcer Recurrence

Diabetic foot ulcers often present a major treatment challenge due to their slow healing and high recurrence rates. A recent study explored a technique commonly used in burn care—measuring skin water loss—to evaluate its potential in predicting whether a foot ulcer might return.

A Serious Complication of Diabetes

Foot ulcers are a frequent and serious complication of diabetes, often leading to prolonged health issues and even limb loss. Their persistence and tendency to reopen make them one of the primary causes of non-traumatic amputations.

In this new research, scientists adapted a technique traditionally used to assess skin damage in burn patients—transepidermal water loss (TEWL)—to evaluate the likelihood of previously healed diabetic foot ulcers reopening.

“This study marks an important early effort to provide clinicians with a practical and objective tool to assess a patient’s risk of foot ulcer recurrence,” said Dr. Teresa Jones, a co-author and Program Director at the NIH’s National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). “Diabetic foot ulcers are a complex and recurring issue, and being able to identify which healed wounds are most likely to break down again could have a major impact on outcomes.”

In burn care, skin damage disrupts its ability to retain moisture, resulting in high TEWL—a condition that can contribute to dehydration, electrolyte imbalance, and delayed healing. Because TEWL reflects skin barrier function, researchers theorized that elevated TEWL in a healed ulcer area could indicate vulnerability to reulceration in diabetic patients.

How the Study Was Conducted

To test this, the team enrolled over 400 adults with diabetic foot ulcers that appeared healed upon visual inspection. Using a commercially available, handheld probe, researchers measured TEWL five times around each wound site—positioned at 3, 6, 9, and 12 o’clock—and once in the center. The researchers took a comparison reading from the same location on the opposite, unaffected foot.

For the study, wound closure followed FDA definitions for chronic and burn wounds: visible skin regrowth (re-epithelialization) without drainage or dressings for two consecutive visits, spaced two weeks apart.Researchers monitored participants for up to 16 weeks, checking in with them weekly by phone to determine whether their ulcers had returned. They defined recurrence when participants answered “yes” to both of the following questions: “Do you see any discharge from the closed wound?” and “Has the wound reopened?”

High TEWL Linked to Greater Risk

By week 16, 21.5% of participants had experienced ulcer recurrence. Among those, 35% had shown high TEWL readings, while only 17% of participants with low TEWL experienced recurrence. In fact, patients with high TEWL were nearly three times more likely to report a recurring wound.

This study connects clinical outcomes like wound closure with more patient-focused goals such as time spent in remission,” the researchers concluded. “It also underscores the importance of revisiting how we define successful healing—emphasizing not just closure, but restoration of full skin barrier function.

Read the original article on: New Atlas

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