Predictors of Changes in Physical Properties of Skin in Patients with Diabetes Mellitus
Introduction: The skin, the largest human organ, is often affected by diabetes mellitus (DM). We know that DM affects the hydration of stratum corneum (SC), the sebum content of the skin and to some extent, the barrier function of the epidermis and elasticity, but we do not know the factors leading to these changes. Objectives: The objectives of this study were to determine the factors associated with changes in physical properties of the skin (skin hydration degree, sebumetry, transepidermal water loss and skin elasticity) in patients with diabetes. Materials and methods: The physical properties of the skin were assessed using the Multi Probe Adapter Systems MPA ® (Courage-Khazaka, Germany) in 57 patients with diabetes and 46 non-diabetic. Results: Statistical analysis of the entire group of 103 subjects showed a significant association between female gender and decreased SC hydration (p<0.05 in all cases), decreased values of transepidermal water loss (TEWL) (β=-0.282, p=0.006) and decreased elasticity of the skin in forearm (β=-0.216, p=0.043). Also, the presence of DM was negatively associated with levels of SC hydration measured on the forearm (β=-0.281, p=0.005). Furthermore, in patients with diabetes, the presence of diabetic neuropathy (DNP) was negatively associated with the hydration of SC measured at all levels (forearm: β=-0.465, p<0.001; leg: β=-0.590, p<0.001; tight: β=-0.198, p<0.001). The observed relationship was independent of age and sex of the participants (p<0.05 after adjustment for age and sex). Regarding skin elasticity, increasing age was associated with lower levels of skin elasticity both in entire group and in patients with DM, at all sites of measurements (p<0.05 in all cases). Additionally, in patients with diabetes, elasticity of the skin measured at forearm and tight was negativelly associated with type of DM (forearm: β=-0.335, p=0.023; tight: β=-0.522, p<0.001). In our study, nor diabetes neither DNP were not associated with TEWL values. Conclusions: The presence of DNP seems to be the main predictor of decreased SC hydration in all measuring points and skin elasticity is significantly associated with age. There are some gender-related modification in physical properties of the skin. Surprisingly, type 2 DM was associated with reduced elasticity in the thigh, and this association was independent of age and sex.