Marc A. Brenner, DPM

The skin is the body's largest organ. Xeroderma or xerodermia, derived from the Greek words for 'dry skin," is a condition involving the integumentary system, which in most cases can safely be treated with emollients and/or moisturizers. Kerosis, also known as asteatosis or winter itch, is common on the feet.

Diabetics commonly experience dehydration because their body has less natural lubrication. This dryness not only causes constant thirst, but can also lead to cracks in the skin. Protecting and restoring the skin, if injured, is one of the most important preventative measures that can be implemented since the skin serves as the body's own bacterial barrier.

Treatment of the diabetic foot must involve a major emphasis, on the part of both the physician and the patient, on both foot consciousness and routine foot care.  Everyone neglects feet and even physicians tend not to examine them. Studies across the country have shown that only a small percentage of physicians take the time to examine the feet of a diabetic patient. It's no surprise that when patients come in with congestive heart failure and other problems associated with diabetes, that these conditions take priority.

The day-to-day responsibility for healthy feet, however, lies with the patient. Unfortunately, the body's first warning system – pain – may not signal the person with diabetes, or even a podiatrist, when something begins to go wrong with the feet. It's up to the individual in cooperation with the podiatrist to develop an alternative warning system.  In individuals with diabetes the feet tend to sweat less than normal.  Using a moisturizer helps to prevent dry, cracked skin. A simple daily regimen requires just a few minutes of "pampering."  Using a non-prescription moisturizer/emollient like Gordon's Vite A Creme on the feet is a very important step for diabetics. As we know, many diabetics have poor eyesight and cannot see the bottom of their feet well. They often need to rely on a family member or a large mirror to examine any changes on their feet, and they must look for these changes on a daily basis.

In regards to cleaning, a person with diabetes should limit baths or showers to five minutes to avoid drying out the skin, and should never soak their feet. A patient who has extremely dry skin should not bathe every day as too much washing depletes natural oils. Since the patient may have diminished sensitivity in their hands as well as their feet, bath water should be tested first with an elbow, back of a wrist or a thermometer to make sure it's not too hot. A simple hydrating cream like a Vitamin A preparation should be applied at night after another inspection of the feet. Wearing a combination of cotton and synthetic socks to bed after applying moisturizer also helps and proper footgear is an absolute must.

It is generally accepted that the water content of the outermost layer of skin (stratum corneum) is a controlling factor in maintaining skin flexibility. When the stratum corneum contains at least 10% water, it remains soft and pliable. When the water content drops below 10% the skin becomes less flexible and rough, and may show scaling and cracking making symptomatic relief important.

Foot problems often begin subtly, with something as simple as a blister, bunion, callus, or most commonly, xeroderma.  High pressure on the foot combined with dry brittle skin leads to callus formation.  The callus acts as a foreign body, further increasing the already high pressures applied on healthy tissue.  Chronic and repetitive pressure, such as from an improperly fitting shoe rubbing, can initially lead to an inflammatory process, which may lead to more dangerous situations in diabetics especially those such as neuropathy and/or arterial embarrassment.

People are well aware that the feet are our foundation.  As such, they need more protection, more pampering, and more medical/general attention.  Daily inspections, continuous cosmetic creaming, increased foot consciousness, and better footgear will lead to immediate benefits for the foot sore population.  This of course will save limbs and lives.

CASE STUDY

A 66 year old Caucasian male, non-diabetic, non-smoker presents with an area of thickened hyperkeratotic, fissured tissue at right heel for 2 ½ months in duration. Pedal pulses intact, DTR, vibration are within normal limits. Denies allergies and takes hypertensive and cholesterol medication. No other complaints, and no recent hospitalizations.

Treatment plan consists of podiatric debridement with a #10 blade and mechanical file and vacuum. Followed by twice daily usage of Gordon's Vite A Crème, which will continue for an indefinite period.

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Gordon Laboratories, located in suburban Philadelphia, is a leading manufacturer of topical pharmaceuticals today, continuing its tradition of innovation and service to Physicians, drug wholesalers, hospitals and pharmacies. The highest quality products and services remain our top priority. To learn more about Gordon Laboratories and its products and services, visit www.gordonlabs.net or call 800-356-7870.