Skin Blood Flow in Diabetic Dermopathy

Wigington, Greg; Ngo, Binh; Rendell, Marc

doi:10.1001/archderm.140.10.1248

Cited by 44 publications

(40 citation statements)

References 27 publications

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“…Furthermore, there was a significant decrease in the blood volume changes of the neuropathic group compared with that of the control group in the fingers (p \ 0.001) and a significant increase in the toes (p \ 0.001). The above finding is consistent with the study wherein 76% of diabetics with neuropathy showed smaller finger pulp and larger toe pulp blood flows than non-diabetics [20]. Therefore, this finding not only validated previous studies [6, 8-10, 13, 16, 20] but confirmed our assumption that the toe blood volume changes in the neuropathic group would be larger than those in the nonneuropathic group.…”

Section: Blood Volume Change and Skin Temperaturesupporting

confidence: 93%

“…This causes increased blood flow in the feet [4] and toes, but does not have an effect on blood flow in the fingers [6]. On the contrary, diabetics with neuropathy showed smaller finger pulp and larger toe pulp blood flows than non-diabetics using laser Doppler (LD) [20]. Therefore, the toe to finger blood flow ratio in diabetics with neuropathy is larger than that in diabetics without it due to the presence of constant or decreased finger blood flow coupled with an increased toe blood flow.…”

Section: Introductionmentioning

confidence: 99%

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A new method of screening for diabetic neuropathy using laser Doppler and photoplethysmography

Kim

Nam

et al. 2007

Med Bio Eng Comput

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The purpose of this study is to suggest a simple, new method of screening for diabetic neuropathy. We measured blood volume changes by photoplethysmography (PPG) and blood perfusion by laser Doppler (LD) in the index fingers and big toes in 40 control subjects and in 50 (19 mild, 17 moderate, and 14 severe based on the nerve conduction velocity (NCV) test) and 35 diabetic patients with and without neuropathy, respectively. According to the results of PPG and LD measurements, the toe to finger ratios obtained from the neuropathic group were significantly higher than those from the control (p < 0.001) and the non-neuropathic groups (p < 0.001). Based on the NCV, the sensitivity of the LD method (92.0%) was higher than that of the PPG method (84.0%) for both left and right sides. Although specificity of the LD (92.8%) was also higher than the PPG (84.3%) bilaterally, the PPG showed better reproducibility (5.5 versus 9.5%) and a significant ratio increase with severity, while the LD did not. Our suggested PPG method using the toe to finger ratio is reliable, simple, economical, and accurate, and could become an effective new screening tool for the early detection of diabetic neuropathy.

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Section: Blood Volume Change and Skin Temperaturesupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

A new method of screening for diabetic neuropathy using laser Doppler and photoplethysmography

Kim

Nam

et al. 2007

Med Bio Eng Comput

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“…Recently, Wigington et al [4] have shownreduced skin blood flow in patients with diabetic dermopathy using laser Doppler technology, although not at the dermopathy sites and put forward the hypothesis that the scarring in diabetic dermopathy is related to low skin perfusion[.] The putative common pathogenesis of diabetic complications arose researchers’ interests in their possible clinical association, considering dermopathy as a presumptive clinical sign of internal complications of diabetes.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, it can be prevented through meticulous control of blood glucose, frequent ophthalmologic examination and its early detection and management. On the other hand, diabetic dermopathy is the most common cutaneous finding in diabetes, occurring in as many as 40% of diabetic patients older than 50 years [4] and has been described as circumscribed hyperpigmented atrophic macules, most commonly observed on the shins, readily diagnosed on examination [5,6,7]. Studies have revealed some correlation between dermopathy and other microangiopathic presentations of diabetes such as retinopathy [8], nephropathy [8, 9] and angiopathic changes in the heart and brain [9].…”

Section: Introductionmentioning

confidence: 99%

Dermopathy and Retinopathy in Diabetes: Is There an Association?

Abdollahi

Daneshpazhooh²,

Amirchaghmaghi

et al. 2007

Dermatology

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Background/Aims: Diabetic dermopathy is the most common cutaneous marker of diabetes mellitus presenting as single or multiple well-demarcated brown atrophic macules, predominantly on the shins. Although diabetic dermopathy and diabetic retinopathy are both considered by some authors as manifestations of diabetic microangiopathy, only a few studies are published about their possible association. Our purpose was to investigate the association of diabetic dermopathy and diabetic retinopathy. Methods: We conducted a cross-sectional study in an outpatient diabetes clinic during a 6-month period. One-hundred and eighty-one consecutive patients (8 cases of insulin-dependent diabetes mellitus and 173 cases of non-insulin-dependent diabetes mellitus) were examined for the presence of diabetic dermopathy and diabetic retinopathy. Results: Forty-seven (26%) showed diabetic dermopathy and 68 patients (37.6%) suffered from diabetic retinopathy. The frequency of retinopathy in patients with diabetic dermopathy (44%; 30 cases) was significantly greater than in patients without dermopathy (15%; 17 cases; p < 0.0001). Retinopathy showed a statistically significant association with dermopathy [odds ratio (OR): 3.60; 95% confidence interval (CI): 1.53–8.44; p = 0.003] and diabetes duration (OR: 3.36; 95% CI: 1.67–6.77; p = 0.001). Conclusion: Our study further supports that diabetic dermopathy might be used as a telltale sign of diabetic retinopathy, necessitating more intensive ophthalmologic care, especially in long-lasting diabetes.

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“…Although patients with diabetic dermopathy exhibit reduced skin blood flow and volumes, it is still a matter of debate whether diabetic dermopathy represents a local ischemic process or not (Netten et al, 1996;Urbanic-Rovan et al, 2004;Wigington et al, 2004).…”

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confidence: 99%

The Cutaneous Microvascular Architecture of Human Diabetic Toe Studied by Corrosion Casting and Scanning Electron Microscopy Analysis

Sangiorgi

Manelli

Reguzzoni

et al. 2010

The Anatomical Record

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In this morphological study, we report on the three-dimensional microvascular architecture constituting the toes of a patient affected by diabetic microangiopathy. We applied corrosion casting (CC) technique to the toes of a patient affected by Type 2 diabetes, who underwent surgery for explantation of inferior left limb due to necrotic processes of soft tissues. The toes of a foot traumatically explanted in a motorcycle accident were kept as controls. According to technical protocols, toes were injected with a low-viscosity acrylic resin (Mercox) through the major digital artery, tissues were corroded in KOH solution (8%), and resulting casts processed for SEM observations. Already at low magnification, in diabetic toes, we found an impairment of the linear track-like disposition of the vessels of plantar side, with signs of vascular disruption and obliterations, stopped resin, and leakages. Capillaries under the nail and a lot of vascular villi in eponychium and nail borders were damaged, and vascular regression phenomena acting on them were clearly visible. Resin leakages and impairment of normal vascular architecture were also observed in the root of the nail. This preliminary report represents only the first step for further investigations regarding morphological three-dimensional appearance of diabetic microangiopathy. CC and scanning electron microscopy technique well documented these morphological modifications, highlighting on both structural and ultrastructural features of diabetic toes microvessels. In conclusion, our qualitative data try to better focus on the pathophysiological mechanisms involved in diabetic dermopathy and microangiopathy, proposing CC as useful method to investigate on them.

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Skin Blood Flow in Diabetic Dermopathy

Cited by 44 publications

References 27 publications

A new method of screening for diabetic neuropathy using laser Doppler and photoplethysmography

A new method of screening for diabetic neuropathy using laser Doppler and photoplethysmography

Dermopathy and Retinopathy in Diabetes: Is There an Association?

The Cutaneous Microvascular Architecture of Human Diabetic Toe Studied by Corrosion Casting and Scanning Electron Microscopy Analysis

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