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Relationship between local neuroimmune impairment and diabetic foot: the immunocompromised district theory
Author(s) -
Baroni Adone,
Russo Teresa,
Piccolo Vincenzo
Publication year - 2014
Publication title -
international journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.677
H-Index - 93
eISSN - 1365-4632
pISSN - 0011-9059
DOI - 10.1111/ijd.12328
Subject(s) - medicine , diabetes mellitus , disease , vascular disease , peripheral , immune system , diabetic foot , peripheral neuropathy , lymphatic system , immunology , receptor , neuroscience , pathology , endocrinology , biology
Background Diabetic foot ( DF ) can be defined as an infection and/or an ulceration with or without destruction of deep tissues associated with neurological abnormalities and varying degrees of peripheral vascular disease of the lower limb in patients with diabetes. Both neuropathy and vascular disease, along with the well‐known impairment of immune function in patients with diabetes, contribute to polymicrobial foot infections, which further aggravate the already severe clinical manifestations of diabetes. Discussion The immunocompromised district ( ICD ) is a novel pathogenic concept referring to a site in which there is an obstacle to the normal trafficking of immunocompetent cells through lymphatic channels, and/or interference with the signals that neuropeptides and neurotransmitters, released by peripheral nerves, send to cell membrane receptors of immunocompetent cells. These loci minoris resistentiae have the propensity to develop a secondary disease, which may occur after an extremely variable length of time. Conclusions In this work, we provide an overview of etiopathogenetic mechanisms of DF and propose a unifying view of this topic based on the concept of the ICD .