From the Guidelines
The skin temperature gradient is a significant indicator of inflammation and disease activity in patients with diabetes, particularly in those with suspected Charcot neuro-osteoarthropathy, and should be assessed using infrared thermometry to measure skin temperature of the feet. This is based on the most recent and highest quality study available, which recommends using infrared thermometry to monitor active Charcot neuro-osteoarthropathy and identify remission 1.
Key Points to Consider
- The skin temperature gradient refers to the difference in temperature between the affected and unaffected foot, which can be a reliable measure of inflammation and disease activity in patients with diabetes 1.
- Infrared thermometry is a relatively simple, inexpensive, and objective method to monitor changes in skin temperature over time, and can be used to calculate the temperature difference between the affected and unaffected foot 1.
- A temperature difference of 2°C or 4°F (2.2°C) between the affected and unaffected foot has been used as a diagnostic threshold for active Charcot neuro-osteoarthropathy in several publications 1.
- However, isolated elevation of foot skin temperature is not sufficient to diagnose or rule out active Charcot neuro-osteoarthropathy, and should be interpreted in the context of other clinical findings 1.
Clinical Implications
- Assessing the skin temperature gradient using infrared thermometry can help detect circulatory problems and inflammation in patients with diabetes, and can be used to monitor disease activity and response to treatment.
- Clinicians should consider using infrared thermometry to measure skin temperature of the feet in patients with diabetes and suspected Charcot neuro-osteoarthropathy, using a standardized approach to the measurement of temperatures to allow for more accurate comparison over time 1.
- The findings of temperature measurement, clinical oedema, and imaging should all be considered when concluding that the active Charcot neuro-osteoarthropathy is in remission 1.
From the Research
Significance of Skin Temperature Gradient
The skin temperature gradient is a significant indicator of various physiological and pathological conditions. Some of the key aspects of skin temperature gradient are:
- Predictive value for mortality: A high core-to-skin temperature gradient is associated with increased mortality in septic shock patients 2.
- Marker for hypoperfusion: Skin temperature at the extremities has been proposed as a non-invasive marker for hypoperfusion in critically ill adults, although the evidence is not conclusive 3.
- Influence of environmental conditions: The validity of contact skin temperature sensors is influenced by the microclimate temperature and body coverings, which can affect the accuracy of skin temperature measurements 4.
- Association with sleep disturbances: Abnormalities in the 24-hour rhythm of skin temperature have been observed in patients with cirrhosis, which may contribute to their sleep disturbances 5.
- Cardiovascular responses to exercise: Increasing skin temperature with narrowing of the core-to-skin temperature gradient can affect cardiovascular responses to exercise, including increases in heart rate and decreases in stroke volume 6.
Clinical Implications
The skin temperature gradient has several clinical implications, including:
- Monitoring of critically ill patients: Skin temperature monitoring can be used as a non-invasive tool to assess peripheral perfusion and predict mortality in critically ill patients 2, 3.
- Diagnosis of hypoperfusion: Skin temperature can be used as a marker for hypoperfusion, although further research is needed to confirm its accuracy 3.
- Management of sleep disturbances: Assessment of skin temperature rhythms may be useful in identifying patients with cirrhosis who are at risk of sleep disturbances 5.
- Optimization of exercise performance: Understanding the effects of skin temperature on cardiovascular responses to exercise can help optimize exercise performance in various environmental conditions 6.