Elder wound care: Both nutrition and medications affect wound healing

October 1, 2008

Several risk factors can impair the wound-healing process in the elderly, such as poor nutrition, depression and the inappropriate use of medications. A focal point in wound healing is the investigation of drugs with the potential to limit scarring. Researchers are identifying targets, such as Transforming Growth Factor-beta3, to develop therapies aimed at minimizing scarring.

Key Points

Toronto – Older people can heal as well as younger people, though the process may take longer.

Clinicians should screen older adults for poor nutrition, the presence of depression, physical mobility and the inappropriate use of medications.

Patient activities

"If you see a patient who has a leg ulceration, you need to explore why the ulceration is there," Dr. Reddy says, stressing that clinicians need to look at the daily activities of the patient and not just their wounds.

"It could be that the person has fallen. If they have fallen more than twice, they should be referred for a geriatric assessment," she says.

Factors that can affect wound healing in elderly patients include adverse drug reactions, significant weight loss, smoking and dementia, Dr. Reddy tells Dermatology Times.

It is also worth considering whether an elderly patient is getting sufficient vitamin D to ensure proper wound healing. About 15 minutes each day usually represents a healthy amount of sun exposure, according to Dr. Reddy.

Maturation of scars

Interestingly, age plays a role in the maturation of scars.

In a study of 58 healthy males from Manchester, England, published in May 2008, investigators found that scar maturation was a result of defined macroscopic and microscopic stages that took shape over a year.

Subjects ages 55 and older experienced accelerated maturation, while their younger counterparts, ages 30 and younger, experienced a retarded rate of maturation.

The study of scar development and scar prevention is a burgeoning area in wound healing.

Several agents are being investigated for their potential in healing wounds, says Mark Ferguson, Ph.D, professor of life sciences at the University of Manchester, England, and co-founder of Renovo, a biotechnology company that is developing and testing various compounds for their wound-healing properties.

"Many people don't want scars because they are aesthetically not nice to look at. Most people want their scars to be less noticeable. They can cause functional problems if they are over a joint.

"We have found that most patients value even a small improvement in scarring. People are not necessarily looking for a miracle," he says.

Dr. Ferguson says that there are no therapies that are indicated to either treat or prevent scars, and that therapies that have shown some benefit have been used in an off-label fashion.

The investigators conducting research on behalf of Renovo have demonstrated that embryonic wounds can heal without scarring, and that the pathophysiology of why scars develop has allowed for the identification of targets and therapies.

New hope

One of the key targets that Renovo's scientists have identified is Transforming Growth Factor-beta3 (TGF-beta3), and they continue to study cellular and molecular distinctions between embryonic wound healing, which is scar-free, and adult wound healing, where scars have formed.

In a recently published study on scar redness in humans conducted by Dr. Ferguson and colleagues, investigators found that scar redness and maturation were more prominent in incisional and excisional wounds that were not treated with TGF-beta3, compared to those wounds that were treated with various doses of the drug.

They also observed that the wound type and position affected how quickly scar redness faded.

Known by the trade name Juvista® (avotermin), human recombinant TGF-beta3 is being investigated in clinical trials for its prophylactic ability to reduce scarring, Dr. Ferguson says.

"The product is not designed to replace surgery, but to augment good clinical technique," he says. "If a plastic surgeon is a good one, the use of this will make them a very good one."

The key to the efficacy of Juvista® is early intervention, Dr. Ferguson says, noting that self-amplifying cascades of growth factors are triggered by the release of stored growth factors, such as TGF-beta1 and platelet-derived growth factor, from degranulating platelets when a wound first appears.

Pharmaceutical scar-preventing drugs must be administered early on to influence the cascades to produce healing with improved scarring.