Role of sex hormones in acute and chronic wound healing

The sex hormones oestrogen and testosterone are important mediators of wound repair. Oestrogen enhances wound healing by reducing inflammation and enhancing matrix production. However, in post-menopausal women, when oestrogen levels are decreased, wound healing is impaired and susceptibility to chronic non-healing wounds increases. Surprisingly, although the speed of healing is impaired, an improvement in the quality of scarring is observed. Testosterone, in contrast, inhibits wound repair and is associated with enhanced inflammation. One of the most important consequences of hormonal changes is the age-related delay in cutaneous wound healing observed in both males and females, which leads to substantial morbidity and mortality. Manipulation of hormone levels may provide alternative treatments for promoting healing in non-healing wounds and may be of value in promoting reduced scarring. Strudwick X, Powell BC & Cowin AJ. Role of sex hormones in acute and chronic wound healing. Primary Intention 2006; 14(1):35-38. Xanthe Strudwick • Bsc (Hons) 1, 2 Barry C Powell • PhD 1, 2, 3 Allison J Cowin* • PhD 1, 2 1. Skin Biology Laboratory Child Health Research Institute 72 King William Road, North Adelaide, SA 5006 2. Department of Paediatrics University of Adelaide, SA 3. School of Pharmacy and Medical Sciences University of South Australia, SA * Corresponding author thickness, occur after menopause 1. Oestrogen can reverse age-related impaired healing in females when applied topically or given systemically and is associated with reduced local inflammation and enhanced matrix deposition 2. In this regard, recent reports have shown that hormone replacement therapy (HRT) prevents the development of chronic wounds in postmenopausal women 3, 4. The presence of the oestrogen (estrogen) receptor (ER) in normal skin fibroblasts, as well as in wound fibroblasts and inflammatory cells of both young and aged males and females, suggests that local oestrogen levels may influence cutaneous physiology, including the wound healing process. The positive effect of topical oestrogen has been shown in elderly women and men, reflecting the marked decrease in local oestrogenic activity as a result of reduced ovarian activity in women, a decline in the adrenal oestrogenic precursor dehydroepiandrosterone in men and women, and altered aromatisation of systemic precursors to local active oestrogen 5. In aging females, although cutaneous wound healing is delayed, there is an improvement in the quality of scarring; studies have shown that this is associated with reduced levels of transforming growth factor-b1 (TGF-b1) 6. Exogenous addition of oestrogen accelerates wound healing and involves oestrogen-induced increases in TGF-b1 secretion by dermal fibroblasts, leading to increased scarring. Exogenous Strudwick X, Powell BC & Cowin AJ Role of sex hormones in acute and chronic wound healing