Burning Feet due to Diabetic Neuropathy
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Department Editor: Tania J. Phillips, MD, FRCPC
Overall Learning Objective: The physician or podiatrist participant will develop a rational approach to the evaluation and treatment of a variety of uncommon wounds and will have an increased awareness of the differential diagnosis of cutaneous wounds and the systemic diseases associated with these wounds.
Submissions: To submit a case for consideration in Diagnostic Dilemmas, e-mail or write to: Executive Editor, WOUNDS, 83 General Warren Blvd., Suite 100, Malvern, PA 19355, firstname.lastname@example.org
Completion Time: The estimated time to completion for this
activity is 1 hour.
Target Audience: This CME/CPME activity is intended for dermatologists, surgeons, podiatrists, internists, and other physicians who treat wounds.
At the conclusion of this activity, the participant should be able to:
1. Describe and discuss diabetic neuropathy
2. Describe the possible role of hyperglycemia in the development of diabetic neuropathy
3. Describe the mechanism of action of doxepin in the management of pruritus and neuropathic pain
4. Administer topical doxepin safely.
Disclosure: All faculty participating in Continuing Medical Education programs sponsored by HMP Communications, LLC, are expected to disclose to the program audience any real or apparent conflict(s) of interest related to the content of their presentation. Drs. Al-Muhairi and Phillips disclose that they have no conflicts of interest relevant to the content of this article.
Accreditation: HMP Communications, LLC, is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. HMP Communications, LLC, is approved by the Council on Podiatric Medical Education as a sponsor of continuing education in podiatric medicine.
Designation: HMP Communications, LLC designates this continuing medical education activity for a maximum of 1 credit hour in category 1 credit toward the AMA Physician’s Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity. HMP Communications designates this continuing medical activity for .1 CEUs available to participating podiatrists.
Method of Participation: Read the article, take, submit, and pass post-test by August, 2004.
This activity has been planned and produced in accordance with the ACCME Essential Areas and Policies.
Release date: 8/10/03
Expiration date: 8/10/04
Burning Feet due to Diabetic Neuropathy
A 66-year-old Caucasian woman recently presented at the wound clinic with severe burning sensations in both soles of her feet, which worsened at night and disturbed her sleep. She has been an outpatient at the clinic for several years for multiple lower-extremity ulcerations due to cryofibrinogenemia. The patient has insulin-dependent diabetes. Clinical exam revealed a pleasant, pale looking woman with normal vital signs. Examination of lower extremities revealed atrophic scars on left medial and lateral malleoli, the sites of healed ulcers. Skin on both feet was hypersensitive to touch and pressure, peripheral pulses were intact, and capillary refilling time was normal.
1. Boulton AJ, Malik RA. Diabetic neuropathy. Med Clin N Am 1998;82(4):909–29. 2. Vinik AI. Neuropathy: New concepts in evaluation and treatment. South Med J 2002;95(1):21–3. 3. Vaillancourt PD, Langevin HM. Painful peripheral neuropathies. Med Clin N Am 1999;83(3):627–42. 4. McCleane G. Topical application of doxepin hydrochloride, capsaicin, and a combination of both produces analgesia in chronic human neuropathic pain: A randomized, double-blind, placebo-controlled study. Br J Clin Pharmacol 2000;49:574–9. 5. Galloway KS, Yaster M. Pain and symptom control in terminally ill children. Pediatr Clin N Am 2000;47(3):699–710. 6. McCleane GJ. Topical doxepin hydrochloride reduces neuropathic pain: A randomized, double-blind, placebo controlled study. Pain Clin 2000;12(1):47–50. 7. Calcutt NA, Dunn JS. Diabetic neuropathy. Anesthesiol Clin N Am 1997;15(2):429–44. 8. Sabroe RA, Kennedy CT, Archer CB. The effects of topical doxepin on responses to histamine, substance P, and prostaglandin E2 in human skin. Br J Dermatol 1997;137(3):386–90. 9. Drake LA, Cohen L, Gillies R, et al. Pharmacokinetics of doxepin in subjects with pruritic atopic dermatitis. J Am Acad Dermatol 1999;41(2):209–14. 10. Demling RH. Topical doxepin cream is effective in relieving severe pruritus caused by burn injury: A preliminary study. Wounds 2001;13(6):210–5. 11. Karaz SS, Moeckli JK, Davis W, et. al. Effect of topical doxepin cream on skin testing. J Allergy Clinical Immunol 1995;96(6):997–1000. 12. Etter L, Myers S. Pruritus in systemic disease: Mechanisms and management. Dermatolog Clin 2002;20(3):459–72. 13. Rothe MJ. Atopic dermatitis: An update. J Am Acad Dermatol 1996;35(1):1–13. 14. Medscape DrugInfo. Doxepin HCL topical. Usage and dosage. Located at www.medscape.com. Access date: April 1, 2003.