From the Guidelines
Patients with diabetes and peripheral artery disease (PAD) often have skin changes in their legs, including thin, shiny skin, loss of hair on legs and feet, dry, cracked skin, discoloration, coolness to touch, slow-healing wounds or ulcers, and thickened toenails, as a result of reduced blood flow and nerve damage, as noted in the most recent guidelines 1. These changes can be attributed to the combination of reduced blood flow due to PAD and nerve damage from diabetes.
- Regular skin inspection and moisturizing are crucial to prevent further complications.
- Patients should avoid injuries, wear proper footwear, and seek immediate care for any wounds.
- Good blood sugar control and management of PAD (e.g., with medications like aspirin or cilostazol) can help prevent worsening of skin conditions.
- Prompt treatment of any skin issues is essential to prevent complications like infections or ulcers, as emphasized in recent guidelines 1. The characteristics of the skin on the legs of a patient with diabetes and PAD can be summarized as follows:
- Skin integrity is compromised due to reduced blood flow and nerve damage
- Increased risk of slow-healing wounds or ulcers
- Discoloration and coolness to touch due to poor circulation
- Dry, cracked skin and loss of hair on legs and feet
- Thickened toenails It is essential to note that early recognition of at-risk feet, preulcerative lesions, and prompt treatment of ulcerations and other lower-extremity complications can delay or prevent adverse outcomes, as highlighted in the most recent guidelines 1.
From the Research
Characteristics of Skin on Legs of Patients with Diabetes Mellitus (DM) and Peripheral Arterial Disease (PAD)
- The skin on the legs of patients with DM and PAD may exhibit impaired wound healing due to hyperglycemia, chronic inflammation, micro- and macro-circulatory dysfunction, hypoxia, autonomic and sensory neuropathy, and impaired neuropeptide signaling 2.
- Cutaneous manifestations, such as xerosis and diabetic foot ulcers (DFUs), are common in patients with DM and can impose a significantly impaired quality of life 3.
- Impaired dermal microvascular reactivity (IDMR) has been identified as an emerging risk factor for DFUs, particularly in patients without overt PAD signs 4.
- The pathogenesis of DFUs is multifactorial, and the most common underlying causes are poor glycemic control, peripheral neuropathy, peripheral vascular disease, foot deformity, and poor foot care 5.
- Prognostic markers, such as skin perfusion pressure, toe pressure, and TcPO2, can be used to predict wound healing and amputation in patients with DM and PAD 6.
Key Factors Affecting Skin Characteristics
- Hyperglycemia: can cause impaired wound healing by affecting biological mechanisms of wound healing 2.
- Chronic inflammation: can contribute to impaired wound healing and cutaneous manifestations 2, 3.
- Micro- and macro-circulatory dysfunction: can lead to impaired wound healing and IDMR 2, 4.
- Hypoxia: can contribute to impaired wound healing and cutaneous manifestations 2.
- Autonomic and sensory neuropathy: can lead to impaired wound healing and cutaneous manifestations 2, 3.
Diagnostic and Therapeutic Considerations
- Debridement is the standard of care for DFU wounds, and several techniques exist 5.
- Prognostic markers can be used to predict wound healing and amputation, and guide management and target interventions for limb salvage 6.
- Revascularization may be necessary for patients with DM and PAD to improve wound healing and prevent amputation 6.