TEWL as a New Predictor of Diabetic Foot Ulcer Recurrence

A Simple but Effective Tool

TEWL, meaning the amount of water escaping through the skin’s surface, has so far been used primarily in the care of burn patients. A new study, however, shows that this measurement can also be useful in patients with diabetic foot, as it reflects the condition of the skin barrier and may be key to a more accurate assessment of true healing quality.

As part of a multicenter study by the NIDDK consortium, which brings together leading research centers focused on the diagnosis and treatment of diabetic foot, more than 400 patients with clinically closed foot ulcers were monitored. At the site of the original lesion, TEWL was measured for each patient, who was then followed up for 16 weeks.

The results revealed a clear trend: the higher the TEWL value, the higher the risk of ulcer recurrence. In patients with high TEWL values (over 30 g/m²/h), 35% experienced ulcer reopening. In contrast, in patients with lower values, recurrence was recorded in only 17% of cases. Higher TEWL thus meant approximately 2.7 times greater risk of ulcer return.

When Is a Wound Truly Closed?

The authors’ findings emphasize the importance of functional, not merely visual, healing assessment. Current clinical definitions of wound closure are based mainly on macroscopic appearance — whether new epidermis is present and whether there is no secretion. However, the study shows that even such “healed” wounds may have a compromised skin barrier, increasing the risk of pathogen entry and recurrent ulceration.

TEWL could therefore serve in the future as a practical, non-invasive indicator to help doctors better determine when a wound is truly closed. The measurement is simple, quick, and feasible in an outpatient setting. According to the authors, it could easily be incorporated into standard care for patients with diabetic foot.

Introducing such an objective parameter could also contribute to better standardization of healing assessment in both clinical trials and routine practice. Although technically straightforward, wider adoption will depend on the availability of measuring equipment and the training of healthcare staff.

Benefits for Amputation Prevention

Diabetic foot ulcers are the leading cause of non-traumatic lower limb amputations. Any tool that enables the early identification of patients at risk of recurrence could therefore significantly reduce the number of these serious complications.

The study’s authors also note that TEWL is not the only risk factor for ulcer development. The duration of the original ulcer, the presence of neuropathy, and other comorbidities also play a role.

Nevertheless, TEWL offers a new, objective perspective on healing quality and can support decisions on follow-up care, prevention, or targeted therapy. Early detection of insufficient closure could allow preventive interventions before ulcer recurrence occurs.

The authors also stress the need for further studies to confirm the long-term predictive value of TEWL in various clinical settings and populations.

Editorial Team, Medscope.pro

Source:
Sen C. K., Gordillo G. M., Roy S. et al. High Transepidermal Water Loss at Wound Closure Site Is Associated With Increased Diabetic Foot Ulcer Recurrence: Results From the NIDDK Diabetic Foot Consortium TEWL Study. Diabetes Care 2025, doi: 10.2337/dc25-0300.