Skin hydration of the heel with fissure in patients with diabetes: a cross-sectional observational study
Received 26 November 2017
Accepted for publication 4 April 2018
Published 12 June 2018 Volume 2018:5 Pages 11—16
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 3
Editor who approved publication: Professor Marco Romanelli
Makoto Oe,1 Kimie Takehara,2 Hiroshi Noguchi,3 Yumiko Ohashi,4 Mayu Fukuda,1 Takashi Kadowaki,5 Hiromi Sanada1,6
1Global Nursing Research Center, 2Department of Advanced Nursing Technology, 3Department of Life Support Technology (Molten), Graduate School of Medicine, The University of Tokyo, 4Department of Nursing, The University of Tokyo Hospital, 5Department of Diabetes and Metabolic Diseases, 6Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Purpose: Foot fissure should be prevented in patients with diabetes due to the likelihood of subsequent diabetic ulcer. The purpose of this study was to investigate a cutoff point for skin hydration with fissure and the factors associated with low skin hydration in patients with diabetes.
Subjects and methods: Subjects were patients with diabetes who visited the diabetic foot clinic and were evaluated for skin hydration on the heel between April 2008 and March 2015. Information about fissure, skin hydration, age, sex, autonomic neuropathy, angiopathy, and tinea pedis were collected from the medical charts. Skin hydration on the heel was measured using a moisture checker. Skin hydration was compared between heels with and without fissure, and a cutoff for skin hydration with fissure was determined using receiver operating characteristic analysis. Based on the determined cutoff, factors associated with lower skin hydration were analyzed using logistic regression analysis.
Results: Participants comprised 693 patients. Mean±SD age was 66.8±10.8 years, and 57.0% of subjects were male. The frequency of fissures on the heels was 10.4%. Area under the receiver operating characteristic curve for skin hydration in the presence of fissure was 0.717. Twenty percent was selected as the cutoff point, offering sensitivity of 0.478 and specificity of 0.819. Logistic regression analysis showed correlations between three factors (male sex, tinea pedis, and room temperature) and skin hydration <20.0% (odds ratio [OR] 1.587, 95% CI 1.157–2.178, p=0.004; OR 1.548, 95% CI 1.122–2.135, p=0.005; and OR 0.900, 95% CI 0.823–0.0985, p=0.021, respectively).
Conclusion: To prevent heel fissures, moisturizing care should aim at achieving skin hydration of 20%. If skin hydration is <20%, prevention of fissures may warrant not only specialized moisturizing care but also consideration of treatment for tinea pedis.
Keywords: xerosis, diabetes mellitus, tinea pedis, moisturizing care
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