By Melanie Fridl Ross
GAINESVILLE, Fla.---Estrogen speeds wound healing in older postmenopausal women, report researchers from England's University of Manchester and the University of Florida in this week's issue of the journal Nature Medicine.
"Based on our results, hormone replacement therapy may prove to be very beneficial to wound healing processes in elderly women," said Roy Tarnuzzer, a research assistant professor in the division of endocrinology and metabolism at UF's College of Medicine and a member of UF's Institute for Wound Research. "Not only does it appear to accelerate the wound healing process, but it may also have effects on chronic wounds that are very difficult to heal in some elderly patients."
Studies have shown that aged skin typically does not repair itself as well or as quickly as in younger individuals, he said.
Tarnuzzer developed a key laboratory technique used in the study -- one of the first reports to examine hormonal regulation of normal skin healing after wounding. The method enables researchers to use very small tissue samples to track how wounds heal.
Researchers studied 10 postmenopausal women ages 55 to 65 who were taking estrogen, 10 postmenopausal women the same age who weren't taking estrogen and 10 premenopausal women ages 20 to 39 who were not taking oral contraceptives.
By removing a 4-mm skin sample from the underside of participants' arms, researchers were able to study how the wounds healed over time.
"We found that elderly postmenopausal women who were on estrogen replacement therapy appeared to heal much the same as the younger women, whereas the postmenopausal patients we studied who were not on hormone replacement therapy showed delayed wound healing," Tarnuzzer said.
Researchers also found striking differences in the amount of collagen and growth factors -- both key players in the healing process -- present at the site of the wounds depending on whether the participant was on estrogen. Collagen keeps skin supple and helps scar formation. Growth factors affect cells' ability to grow and repair wounds.
"There was a lot more collagen in the patients on the hormone replacement therapy, equal to the amounts seen in the young, and decreased levels in those elderly patients not on estrogen. Scar formation and skin tone had changed in these patients," Tarnuzzer said. "There was a similar pattern when we looked at the level of a crucial growth factor produced at the site of injury. The level was similar in patients on estrogen compared with the younger group; those not on hormone replacement therapy showed very low levels of this particular growth factor.
"The inflammatory response -- the cells of the body recruited into the site of injury to orchestrate the wound healing process -- also appeared to differ significantly in the elderly patients who were not taking estrogen," Tarnuzzer added.
The findings suggest hormone replacement therapy or even topical estrogen creams could, in some cases, promote wound healing, Tarnuzzer said.
"The next step is to see what direct effects estrogen or the other hormones in hormone replacement therapy are having on cells within a wound environment, and to determine which cells are really important in this process," he said. "It would be interesting to determine in a real-world setting the incidence of problem wounds with patients who are on hormone replacement therapy and with those who are not."
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