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High Transepidermal Water Loss in Diabetic Foot Ulcer Tied to Recurrence

Medically reviewed by Carmen Pope, BPharm. Last updated on June 3, 2025.

By Elana Gotkine HealthDay Reporter

TUESDAY, June 3, 2025 -- Compromised restoration of the skin barrier function of closed diabetic foot ulcers (DFUs), as measured by high transepidermal water loss (TEWL), is associated with increased odds of recurrence, according to a study published online May 30 in Diabetes Care.

Chandan K. Sen, Ph.D., from the McGowan Institute for Regenerative Medicine at the University of Pittsburgh, and colleagues conducted a multicenter, noninterventional study measuring TEWL in 418 adults with diabetes and a recently healed DFU. Within two weeks of wound closure, TEWL was measured at the center of the closed wound and at an anatomically similar reference area on the contralateral foot; measurements were repeated two weeks later at a wound closure confirmation visit (visits 1 and 2, respectively). To examine wound recurrence, participants were observed for up to 16 weeks.

The researchers found that DFU recurrence occurred in 21.5 percent of participants by week 16. At visit 1, mean TEWL at the center of the healed DFU was higher for those with recurrence versus those without. Overall, 35 and 17 percent of those with high TEWL and low TEWL, respectively, reported wound recurrence. For participants with high TEWL, the odds ratio for recurrence was 2.66. There was high concordance for self-reported wound recurrence with clinician assessment of wound recurrence.

“This study is an important initial step to give clinicians treating diabetic foot ulcers a reliable diagnostic aid for the first time to assess an individual’s risk of ulcer recurrence,” study author Teresa Jones, M.D., from the National Institute of Diabetes and Digestive and Kidney Diseases in Bethesda, Maryland, said in a statement. “Foot ulcers are such a confounding issue with diabetes and being able to determine which wounds are at highest risk for recurrence could save many lives and limbs.”

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Disclaimer: Statistical data in medical articles provide general trends and do not pertain to individuals. Individual factors can vary greatly. Always seek personalized medical advice for individual healthcare decisions.

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Posted June 2025

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