Medications And Wound Healing
Patients with wounds often are provided pharmacologic interventions for their wounds as well as for their acute or chronic illnesses. Drugs can promote wound healing or substantively hinder it; some medications cause wound or skin reactions. A comprehensive review of extant literature was conducted to examine the impact of drug therapy on wound healing and skin health. MEDLINE and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched for English-language articles published between 2000 and 2016 using the terms drugs, medications, drug skin eruptions, adverse skin reactions, wound healing, delayed wound healing, nonhealing wound, herbals, and herbal supplements. The search yielded 140 articles (CINAHL) and 240 articles (MEDLINE) for medications and wound healing. For medications and adverse skin effects, the search identified 256 articles (CINAHL) and 259 articles (MEDLINE). The articles included mostly narrative reviews, some clinical trials, and animal studies. Notable findings were synthesized in a table per pharmacological class and/or agent focusing on wound healing impact and drug-induced adverse skin reactions. The medications most likely to impair wound healing and damage skin integrity include antibiotics, anticonvulsants, angiogenesis inhibitors, steroids, and nonsteroidal anti-inflammatory drugs. Conversely, drugs such as ferrous sulfate, insulin, thyroid hormones, and vitamins may facilitate wound healing. Selected clinical practices, including obtaining a detailed medication history that encompasses herbal supplements use; assessing nutrition status especially protein blood levels affecting drug protein binding; and scrutinizing patient history and physical characteristics for risk factors (eg, atopy history) can help diminish and/or eliminate adverse integumentary outcomes. "Deprescribing" (discontinuing unnecessary medications) should be utilized when possible. Contemporary wound care clinicians must be cognizant of these mitigating clinical approaches.
Medications and Wound Healing
Although surprisingly few oral medications have been shown to directly aid healing, some have potential benefits that are under investigation. This article describes oral drugs that may help build new tissue and speed wound healing as well as medications that can impair healing.
Phenytoin, applied topically, promotes wound healing by inhibiting the enzyme collagenase. It is effective in some low grade pressure ulcers and trophic ulcers due to leprosy. The possibility of systemic absorption and toxicity has limited its use.
Retinoids (derived from vitamin A) have an impact on wound healing through their effects on angiogenesis, collagen synthesis, and epithelialisation. Vitamin A is necessary for normal epidermal maintenance. Although the value of retinoids in chronic wounds is unclear, topical tretinoin (0.05-0.1%) has been shown to accelerate re-epithelialisation of dermabraded and chemically peeled wounds in humans, and partial and full thickness wounds in animal models.
Abstract:Chronic wounds often occur in patients with diabetes mellitus due to the impairment of wound healing. This has negative consequences for both the patient and the medical system and considering the growing prevalence of diabetes, it will be a significant medical, social, and economic burden in the near future. Hence, the need for therapeutic alternatives to the current available treatments that, although various, do not guarantee a rapid and definite reparative process, appears necessary. We here analyzed current treatments for wound healing, but mainly focused the attention on few classes of drugs that are already in the market with different indications, but that have shown in preclinical and few clinical trials the potentiality to be used in the treatment of impaired wound healing. In particular, repurposing of the antiglycemic agents dipeptidylpeptidase 4 (DPP4) inhibitors and metformin, but also, statins and phenyotin have been analyzed. All show encouraging results in the treatment of chronic wounds, but additional, well designed studies are needed to allow these drugs access to the clinics in the therapy of impaired wound healing.Keywords: wound closure; diabetic foot ulcer; DPP4 inhibitor; metformin; phenytoin; statins; drug repurposing
If you receive a serious wound, you should get emergency treatment right away. The doctor will determine the extent and severity of the injury, whether it is likely to get infected, and anything that might complicate treatment. Your health care provider may also order laboratory tests, such as a blood test and urinalysis, as well as a culture to check for bacteria in the wound. You may need stitches, as well as a tetanus shot or a tetanus booster.
PreventionMost wounds are caused by accidents. Make your home safe by removing any objects that might cause trips or falls, keep the water heater at 120 degrees, keep knives and hot pots and pans away from the edge of counters, and pay close attention when using knives. If you get a cut or wound, carefully cleaning and bandaging it can usually prevent infection and other complications.
Wound healing is most successful in a moist, clean, and warm environment. Some wounds, such as minor cuts and scrapes, can be treated at home. Stop the bleeding with direct pressure, and clean the wound with water. You DO NOT need soap or hydrogen peroxide. Apply an antibiotic cream, then cover the wound with an adhesive bandage. Change the bandage every day, or when it gets wet. If any redness spreads from the wound after 2 days, or if you see a yellow drainage from the wound, see your doctor immediately.
Other wounds can be serious. Get emergency care immediately if the wound will not stop bleeding or spurts blood. You should also get immediate care if the wound is from an animal or human bite, or if there is a serious puncture wound. If an object (such as a nail or fishhook) is still stuck in the wound, DO NOT take it out. Apply pressure to the wound to stop bleeding, and go to the hospital.
Your health care provider will determine whether the wound can be closed immediately with stitches, or whether it should be kept open because of contamination. Infected wounds are not closed until the wound has been successfully treated.
You can use complementary and alternative therapies (CAM) for minor household injuries or after more serious injuries have gotten medical attention. If you have any question about whether your wound is serious, call your doctor before using CAM therapies. Never apply any herb or supplement to any open wound without a doctor's supervision.
Some nutritional supplements may help wounds heal, although not all have good scientific studies behind them. If you are having surgery, DO NOT take any herbs or supplements without your doctor's supervision. Lower the dose or stop use when your wound has healed.
Certain herbal remedies may offer relief from symptoms and help wounds heal faster. Herbs are generally available as dried extracts (pills, capsules, or tablets), teas, or tinctures (alcohol extraction, unless otherwise noted). People with a history of alcoholism should not take tinctures. Dose for teas is 1 heaping tsp. per cup of water steeped for 10 minutes (roots need 20 minutes), unless otherwise noted.
Belcaro G, Cesarone MR, Errichi BM, Ledda A, Di Renzo A, Stuard S, et al. Venous ulcers: microcirculatory improvement and faster healing with local use of Pycnogenol. Angiology. 2005 Nov-Dec;56(6):699-705.
Ermertcan AT, Inan S, Ozturkcan S, Bilac C, Cilaker S. Comparison of the effects of collagenase and extract of Centella asiatica in an experimental model of wound healing: an immunohistochemical and histopathological study. Wound Repair Regen. 2008 Sep-Oct;16(5):674-81.
Toon CD, Ramamoorthy R, Davidson BR, Gurusamy KS. Early versus delayed dressing removal after primary closure of clean and clean-contaminated surgical wounds. Cochrane Database Syst Rev. 2013;9:CD010259.
Patients with wounds are frequently treated pharmacologically for both their wounds and their acute or chronic conditions. On a daily basis, patients usually take at least 5 prescription medications to treat multiple chronic conditions, and this level of drug use is termed polypharmacy. Polypharmacy can also be defined as the intake of more medications than are medically necessary for a particular problem or the continuation of intake after the initial problem has been resolved.1,2
Deprescribing medications related to polypharmacy should be considered by physicians as a therapeutic intervention. When deprescribing, clinicians should consider patient and caregiver perspectives on therapy goals, including drug and chronic condition views, as well as prescription preferences and priorities, to accelerate disease management, avoid health deterioration, and relieve symptoms. Point-of-care tools can help physicians deprescribe medications and can also help patients realize the importance of reducing their drug burden to lessen the consequences of polypharmacy.3
Medications that have been reported to delay wound healing include anticoagulants, antimicrobials, various antibiotic classes, bevacizumab, aflibercept, antineoplastic agents, chemotherapeutics, immunosuppressants, and colchicine. Of note are common substances which also delay wound healing, such as sodium hypochlorite and nicotine. 4
Antibiotics should be prescribed only when there is an active wound infection. Both culture and sensitivity testing should be used to guide antibiotic selection, in keeping with antimicrobial stewardship. Prolonged use of topical antibiotics is discouraged to avoid the development of resistant organisms, thereby harming the effectiveness of future antibiotic use.1
Given the major issue of chronic wounds, clinicians confront the public health crisis with solutions such as advanced wound care therapies. There are situations where specific advanced therapies may be advantageous in the healing process for various chronic wounds and for those patients who require medications that may make wound healing difficult. The path to healing for many wounds begins with wound bed cleansing. In fact, the efficacy of numerous advanced therapies is contingent on good wound bed preparation that promotes healing. The success of advanced therapies relies on preparing the wound bed by reducing bacterial burden and inflammation.5 041b061a72