High TEWL Predicts Diabetic Foot Ulcer Recurrence

Summary: A multicenter observational study led by the NIDDK Diabetic Foot Consortium (Sen et al., 2025) reveals that high transepidermal water loss (TEWL) at the site of closed a diabetic foot ulcer (DFU) significantly increases the risk of recurrence within 16 weeks. Using a handheld evaporimeter, researchers measured TEWL at the healed DFU and compared it to a reference site on the opposite foot.

Key Findings:

• Among 418 patients tracked up to 16 weeks post-closure, 21.5% experienced recurrence.
• A TEWL threshold of >30 g/m²/h marked a high-risk group—35% recurrence compared to 17% in the low-TEWL group (OR 2.66; p < 0.001). Self-reported recurrence strongly aligned with clinician assessments.
• This study suggests that visual wound healing alone may not reflect true functional barrier restoration—defined as “invisible wound” when TEWL remains high despite closure. :contentReference[oaicite:2]{index=2}

Implications: Measuring TEWL post-closure may serve as a valuable biomarker to differentiate between visually healed wounds and those at risk of reopening—enabling clinicians to tailor surveillance and interventions to improve long-term outcomes and prevent relapse.

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Keywords: transepidermal water loss, diabetic foot ulcer recurrence, invisible wound, Chandan K. Sen, skin barrier function