Laser-induced auto-fluorescence (LIAF) as a method for assessing skin stiffness preceding diabetic ulcer formation

Abstract Recurrent foot ulceration is a major cause of morbidity in diabetic patients. Discrepancy between the stiffness of the plantar skin and underlying soft tissues may influence the likelihood of ulceration. Tissue properties change with diabetes primarily due to high blood glucose which promot...

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Bibliographic Details
Published in:Journal of biomechanics 2007-01, Vol.40 (4), p.736-741
Main Authors: Tajaddini, Azita, Scoffone, Heather M, Botek, Georgeanne, Davis, Brian L
Format: Article
Language:English
Subjects:
Adult
Age
Aged
Aged, 80 and over
Biopsy
Body mass index
Collagen
Diabetes
Diabetes Mellitus, Type 1 - complications
Diabetes Mellitus, Type 2 - complications
Diabetic Foot - diagnosis
Diabetic Foot - etiology
Diabetic Foot - physiopathology
Female
Fluorescence
Foot Ulcer - diagnosis
Foot Ulcer - etiology
Foot Ulcer - physiopathology
Gender
Glucose
Humans
Lasers
Male
Middle Aged
Physical Medicine and Rehabilitation
Plantar skin
Skin - physiopathology
Skin cancer
Spectroscopy
Spectrum analysis
Ulcers
White people
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Summary:Abstract Recurrent foot ulceration is a major cause of morbidity in diabetic patients. Discrepancy between the stiffness of the plantar skin and underlying soft tissues may influence the likelihood of ulceration. Tissue properties change with diabetes primarily due to high blood glucose which promotes intermolecular cross-linking of structural proteins thus leading to altered structure and function of these structural fibers. This study utilizes a non-invasive method for indirectly assessing skin tissue in the context of plantar ulcer formation in diabetic patients’ feet. Control ( C , n =13), and diabetic subjects with a history of ulceration ( n =16) were matched based on gender, age (42–81years old) and BMI. Six subjects re-ulcerated ( U ) during their 1-year follow-up. At every visit, each subject's plantar skin was excited with a weak laser light (337 nm) to induce tissue fluorescence at three locations on each foot. The spectral area under the curve (AUC) was calculated after background subtraction and normalization. The mean AUC was significantly higher for diabetics compared to control subjects, (mean AUC: 145.6±7.2, C =112.6±8.3, respectively, p =0.006). For those who re-ulcerated ( U , n =6), skin site was not a significant factor, but AUC was diminished at the time of re-ulceration ( p
ISSN:0021-9290
1873-2380
DOI:10.1016/j.jbiomech.2006.10.011