Effects of Steroids and Retinoids on Wound Healing

Wicke, Corinna; Halliday, Betty J.; Allen, D Pascual; Roche, Nanette S.; Scheuenstuhl, Heinz; Spencer, Martin M.; Roberts, Anita B.; Hunt, Thomas K.

doi:10.1001/archsurg.135.11.1265

Cited by 299 publications

(204 citation statements)

References 28 publications

(27 reference statements)

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“…A prior case series of corticosteroid users undergoing THA showed postoperative complications requiring reoperation included periprosthetic fracture, recurrent hip dislocation, and persistent deep infection [20]. Potential mechanisms for the association between corticosteroids and revision include poor bone formation secondary to suppression of osteoblasts [7], poor bone stock increasing the risk for fracture and prosthesis loosening [7], inhibition of collagen deposition and secretion of growth factors leading to impaired wound healing [27], and weakened immune function leading to infection [1,17]. In a future study, long-term followup of chronic corticosteroid users at 5-year and 10-year endpoints would be useful to comprehensively assess implant survival in this patient population.…”

Section: Discussionmentioning

confidence: 99%

Does Chronic Corticosteroid Use Increase Risks of Readmission, Thromboembolism, and Revision After THA?

Boylan

Perfetti

Elmallah

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Systemic corticosteroids are commonly used to treat autoimmune and inflammatory diseases, but they can be associated with various musculoskeletal problems and disorders. There currently is a limited amount of data describing the postoperative complications of THA associated specifically with chronic corticosteroid use. Questions/purposes For chronic corticosteroid users undergoing THA, we asked: (1) What is the risk of hospital readmission at 30 and 90 days after surgery? (2) What is the risk of venous thromboembolism at 30 and 90 days after surgery? (3) What is the risk of revision hip arthroplasty at 12 and 24 months after surgery? Methods We identified patients in the Statewide Planning and Research Cooperative System who underwent primary THA between January 2003 and December 2010. This database provides hospital discharge abstracts for all admissions in the state of New York each year. We used propensity scores to three-to-one match the 402 chronic corticosteroid users with a comparison cohort of 1206 patients according to age, sex, race, comorbidity score, year of surgery, and hip osteonecrosis. The risk of each outcome was compared between chronic corticosteroid users and the matched cohort. Because multiple comparisons were made, we considered p less than 0.008 as statistically significant. Results Readmission was more common for corticosteroid users at 30 days (odds ratio [OR], 1.45; 95% CI, 1.14-1.85; p = 0.003) and 90 days (OR, 1.37; 95% CI, 1.09-1.73; p = 0.007). Venous thromboembolism was not more frequent in corticosteroid users at 30 days (OR, 2.39; 95% CI, 1.08-5.26; p = 0.031) or 90 days (OR, 1.91; 95%

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Section: Discussionmentioning

confidence: 99%

Does Chronic Corticosteroid Use Increase Risks of Readmission, Thromboembolism, and Revision After THA?

Boylan

Perfetti

Elmallah

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…[1][2][3][4] Skin that has become atrophic as a consequence of the aging process also demonstrates impaired wound healing, 5-7 as does skin that has been damaged as a result of extended corticosteroid use. [8][9][10] The majority of wound-healing research is directed toward understanding the pathophysiology of impaired wound healing and identifying interventions that can mitigate the critical patho-physiological events.Several past studies have demonstrated the efficacy of all-trans retinoic acid (RA) and its parent compound all-trans retinol (ROL, vitamin A) in wound healing. Although most studies have focused on wounds in the skin, [11][12][13][14][15][16][17] retinoid efficacy has also been demonstrated in healing of wounds in other tissues (bone, cornea, respiratory tract, upper digestive system, and gut).…”

mentioning

confidence: 99%

MDI 301, a nonirritating retinoid, improves abrasion wound healing in damaged/atrophic skin

Warner

Bhagavathula

Nerusu

et al. 2008

Wound Repair Regeneration

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MDI 301 is a picolinic acid-substituted ester of 9-cis retinoic acid. It has been shown in the past that MDI 301 increases epidermal thickness, decreases matrix metalloproteinase (MMP) activity, and increases procollagen synthesis in organ-cultured human skin. Unlike all-trans retinoic acid (RA), MDI 301 does not induce expression of proinflammatory cytokines or induce expression of leukocyte adhesion molecules in human skin. In the present study we examined topical MDI 301 treatment for ability to improve the structure and function of skin in three models of skin damage in rodents and for ability to improve abrasion wound healing in these models. MDI 301 was applied daily to the skin of rats treated with the potent corticosteroid, clobetasol propionate, to the skin of diabetic rats (8 weeks posttreatment with streptozotocin) and to the skin of aged (14-16-month-old) rats. In all three models, subsequently induced abrasion wounds healed more rapidly in the retinoid-treated animals than in vehicle-treated controls. Immediately after complete wound closure, tissue from the wound site (as well as from a control site) was put into organ culture and maintained for 3 days. At the end of the incubation period, culture fluids were assessed for soluble type I collagen and for MMPs-2 and -9. In all three models, the level of type I collagen was increased and MMP levels were decreased by MDI 301. In all three models, skin irritation during the retinoid-treatment phase was virtually nonexistent.Minor abrasions that occur in healthy skin are expected to heal without incident. Interventions are designed primarily to prevent infection and to provide support for the body's own regenerative mechanisms. In contrast, wounds in chronically damaged and atrophic skin often go on to form nonhealing ulcers with devastating consequences. Diabetes alone is a contributing factor in up to 70% of the > 55,000 amputations that occur annually. [1][2][3][4] Skin that has become atrophic as a consequence of the aging process also demonstrates impaired wound healing, 5-7 as does skin that has been damaged as a result of extended corticosteroid use. [8][9][10] The majority of wound-healing research is directed toward understanding the pathophysiology of impaired wound healing and identifying interventions that can mitigate the critical patho-physiological events.Several past studies have demonstrated the efficacy of all-trans retinoic acid (RA) and its parent compound all-trans retinol (ROL, vitamin A) in wound healing. Although most studies have focused on wounds in the skin, [11][12][13][14][15][16][17] retinoid efficacy has also been demonstrated in healing of wounds in other tissues (bone, cornea, respiratory tract, upper digestive system, and gut). 27 Likewise, skin irritation is also a complication with synthetic retinoidal agents currently on the market. 28 Irritation is a major cause of non-compliance among retinoid users. In addition, excessive irritation may counteract the beneficial effects of retinoid use or actually predispo...

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“…This study demonstrates that the cht/soy membranes, in a rodent model under impaired healing conditions induced by corticosteroid treatment, 49 are suitable wound dressings, allowing the progress of a normal healing path and a faster replacement of the excised epidermis in comparison to an undressed wound (negative control). The presence of granulation tissue at earlier stages of healing was indicative of an accelerated tissue reaction 55 toward the repair of the injured site.…”

Section: Discussionmentioning

confidence: 76%

“…1). At days 0 (surgery day) and 7, methylprednisolone acetate (Depo-Medrol Ò ; Pfizer) was subcutaneously injected (20 mg/kg BW) to impair wound healing 49 and inhibit hair growth.…”

Section: Animalsmentioning

confidence: 99%

In VivoPerformance of Chitosan/Soy-Based Membranes as Wound-Dressing Devices for Acute Skin Wounds

Santos

Höring

Reise

et al. 2013

Tissue Engineering Part A

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Wound management represents a major clinical challenge on what concerns healing enhancement and pain control. The selection of an appropriate dressing plays an important role in both recovery and esthetic appearance of the regenerated tissue. Despite the wide range of available dressings, the progress in the wound care market relies on the increasing interest in using natural-based biomedical products. Herein, a rat wounddressing model of partial-thickness skin wounds was used to study newly developed chitosan/soy (cht/soy)-based membranes as wound-dressing materials. Healing and repair of nondressed, cht/soy membrane-dressed, and Epigard Ò -dressed wounds were followed macroscopically and histologically for 1 and 2 weeks. cht/soy membranes performed better than the controls, promoting a faster wound repair. Re-epithelialization, observed 1 week after wounding, was followed by cornification of the outermost epidermal layer at the second week of dressing, indicating repair of the wounded tissue. The use of this rodent model, although in impaired healing conditions, may enclose some drawbacks regarding the inevitable wound contraction. Moreover, being the main purpose the evaluation of cht/soy-based membranes' performance in the absence of growth factors, the choice of a clinically relevant positive control was limited to a polymeric mesh, without any growth factor influencing skin healing/repair, Epigard. These new cht/soy membranes possess the desired features regarding healing/repair stimulation, ease of handling, and final esthetic appearance-thus, valuable properties for wound dressings.

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Effects of Steroids and Retinoids on Wound Healing

Cited by 299 publications

References 28 publications

Does Chronic Corticosteroid Use Increase Risks of Readmission, Thromboembolism, and Revision After THA?

Does Chronic Corticosteroid Use Increase Risks of Readmission, Thromboembolism, and Revision After THA?

MDI 301, a nonirritating retinoid, improves abrasion wound healing in damaged/atrophic skin

In VivoPerformance of Chitosan/Soy-Based Membranes as Wound-Dressing Devices for Acute Skin Wounds

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