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Case Study
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Estrogen and wound healing: case presentations on the addition of topical estrogen Julie Cucco, RN, MSA, BSN, CWS, Mike Sellers, RN, BSN, CHRN, Neil Adelman, MD, National Healing Corporation, Shelby, MI The objective of this poster is to present two case studies of post-menopausal women whose wound treatment protocol included the addition of topical estrogen to the wound bed. These two case presentations center on women with very recalcitrant lower extremity wounds in which several treatment options failed. The failed treatment protocols involved standard and advanced wound care treatment protocols. In both cases, no significant underlying etiologies were identified. The wound care physician added a bi-weekly dose of topical estrogen to the treatment protocol and was able to achieve total wound healing. Very little research has been conducted on the effect of estrogen on wound healing and the significance of estrogen and other hormones at the cellular level in wound repair. Animal studies and a very limited number of human studies have shown estrogen to have an impact on the inflammotory phase as well as an increase in the collagen synthesis in wound repair. While two case studies does not advocate the addition of topical estrogen therapy to all post-menopausal women, the interest in the need for further research in this area may be warranted. Well controlled, double-blinded studies, as well as additional research on the effect of hormones at the wound cellular level, may offer guidance in additional treatment options for patients with recalcitrant wounds. Ashcroft GS, Greenwell-Wild T, Horan M, Wahl SM, Ferguson M. Topical estrogen accelerates cutaneous wound healing in aged humans associated with an altered inflammatory response. Am J Pathol. 1999;155:1137Ð1146 Ashcroft GS, Ashworth JJ. Potential role of estrogen in wound healing. Am J Clin Dermatol. 2003;4(11):737Ð743..Ashcroft GS, et al. Role of smad3 in the hormonal modulation of in vivo wound healing responses. Wound Repair Regen. 2003;11(6):468Ð473 Brincat MP. Oestrogens and the skin. J Cosmetic Dermatol. 2004;3:41Ð49 Brincat MP, et al. Estrogens and the skin. Climacteric. 2005;8:110Ð123 Pirila E, et al. Chemically modified tetracycline (CMT-8) and estrogen promote wound healing in ovariectomized rats: effects on matrix metalloproteinase-2, membrane type 1 matrix metalloproteinase, and laminin-5 2-chain. Wound Rep Regen. 2002;10:38Ð51 Pirila E, et al. Wound healing in ovariectomized rats: effects of chemically modified tetracycline (CMT-8) and estrogen on matrix metalloproteinases -8, -13 and type I collagen expression. Curr Med Chem. 2001;8:281Ð294 Margolis DJ, Knauss J, Bilker W. Hormone replacement therapy and prevention of pressure ulcers and venous leg ulcers. Lancet. 2002;23:675Ð677. Shah MG, Maibach HI. Estrogen and skin: an overview. Am J Clin Dermatol. 2002;(3):145Ð150. |
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