Overview

• Researchers measured transepidermal water loss (TEWL) in healed ulcers of 418 adults with type 1 or 2 diabetes across seven U.S. NIH Diabetic Foot Consortium sites.
• By week 16, 22% of participants experienced ulcer recurrence and wounds with TEWL values above 30 showed a 2.7-fold higher risk of reopening.
• Investigators warn that the FDA’s current closure definition—based on skin coverage and lack of drainage—does not ensure restoration of barrier function.
• A handheld TEWL device detected “invisible wounds” that appear healed but still allow excess moisture loss and remain vulnerable to infection.
• Authors recommend incorporating TEWL screening into standard closure assessments and call for clinical trials of therapies to restore barrier integrity in high-TEWL sites.