The effect of drugs on wound healing

After surgery, even with frequent suture removal, frequent dressing changes, and careful dietary adjustments, the wound still heals slowly, sometimes remaining open even after months. Many people overlook a crucial factor when searching for the cause: the medications they are taking. Some medications directly interfere with a specific stage of wound healing, inhibiting inflammatory responses, hindering cell proliferation, reducing collagen synthesis, or affecting angiogenesis. Patients may be unaware of these side effects, and doctors may forget to mention them. Finding out if your medications contain ingredients that affect wound healing is sometimes far more effective than switching to a more expensive dressing. 

Which common medications can slow down healing?

Glucocorticoids are a prime example of drugs that negatively impact wound healing. These include prednisone, methylprednisolone, and dexamethasone, and are widely used for autoimmune diseases, allergic diseases, and post-organ transplant rejection. While hormones have a strong anti-inflammatory effect, wound healing requires a normal inflammatory response to clear necrotic tissue and guide repair cells into the wound. Hormones suppress the inflammatory response, reducing the activity of macrophages and fibroblasts, decreasing collagen synthesis, and significantly slowing wound healing. Patients taking hormones long-term have a several times higher risk of postoperative wound dehiscence and infection than the general population. If hormone use is necessary, doctors will try to minimize the dosage during the perioperative period or switch to topical hormones instead of systemic medication.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are another commonly used class of medications, including ibuprofen, naproxen, diclofenac, and celecoxib. Many people buy and take them themselves for joint pain or headaches, and they are also frequently used for pain relief after surgery. These drugs exert their anti-inflammatory and analgesic effects by inhibiting the activity of cyclooxygenase, thereby reducing the synthesis of prostaglandins. However, prostaglandins also play a role in wound healing, promoting angiogenesis and collagen deposition. Experimental studies have shown that conventional doses of NSAIDs can slow wound healing by 15% to 30%. Short-term use for a few days is not a major problem, but long-term use or high doses can have a significant impact on healing. Clinically, for patients requiring postoperative pain relief, acetaminophen (Tylenol) has a smaller impact on wound healing than ibuprofen and can be considered a preferred alternative.

Will diabetes and high blood pressure medications have an effect?

Hypoglycemic and antihypertensive drugs themselves do not have a direct adverse effect on wound healing; in fact, keeping blood sugar and blood pressure within the normal range is an important condition for promoting healing. However, there is an easily overlooked issue: some hypoglycemic drugs increase the risk of hypoglycemia during and after surgery, especially sulfonylureas such as glibenclamide and insulin. In a hypoglycemic state, the body's tissues, including the wound, do not receive sufficient energy, naturally affecting healing. It is necessary to discuss the hypoglycemic plan with the anesthesiologist before surgery to avoid prolonged fasting leading to hypoglycemia. Beta-blockers among antihypertensive drugs, such as metoprolol and atenolol, may theoretically reduce blood flow to the skin, potentially affecting healing. However, clinically, this effect is usually very mild, far less damaging to healing than poor blood pressure control. Therefore, do not arbitrarily stop taking antihypertensive drugs to promote healing; the cardiovascular risks caused by excessive blood pressure fluctuations are far more serious than delayed healing.

Can functional dressings counteract the effects of medication?

For patients taking medications that impair healing, functional wound dressings can offer some local relief, but they cannot completely counteract the systemic effects of the drugs. For example, for patients whose collagen synthesis has decreased due to long-term hormone use, dressings containing collagen or platelet-derived growth factor gel can replenish repair materials locally and promote granulation tissue growth. For patients whose inflammatory response is suppressed by nonsteroidal anti-inflammatory drugs (NSAIDs), silver ion dressings or honey dressings can help control bacteria and reduce the wound's dependence on inflammatory responses. For patients with significant bleeding due to anticoagulant medications, alginate dressings or chitosan dressings have good hemostatic effects and can help absorb hematomas. However, these are only auxiliary measures. The most fundamental approach is to communicate with your doctor to assess whether the systemic medication regimen can be adjusted. If the condition allows for temporarily discontinuing medication or switching to a drug with less impact on healing, that is the best solution.

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Editor: kiki Jia