RECONSTRUCTIVE UROLOGY

The Hormonal Regulation of Cutaneous Wound Healing
Gilliver SC, Ashworth JJ, Ashcroft GS
Faculty of Life Sciences, Michael Smith Building, M13 9PT Manchester, United Kingdom
Clin Dermatol. 2007; 25: 56-62

• Conditions of impaired wound healing in the elderly are associated with substantial morbidity and mortality and impose a significant financial burden upon the world’s health services. The findings of a series of recent studies have served to highlight the contrasting contributions made by sex steroid hormones to the regulation of cutaneous repair processes. Although estrogens accelerate healing, the actions of the “male” sex hormones 5alpha-dihydrotestosterone and testosterone are primarily deleterious. The shift that occurs in the balance between serum estrogen and androgen levels as a normal feature of human aging may therefore have important consequences for fundamental tissue repair processes.
  
  
• Editorial Comment
  The paper outlines nicely the effect of sex hormones on wound healing. Topical and systemic estrogen applications have been shown to both increase acute healing and to prevent the development of a chronic wound status. A similar beneficial effect for wound healing was seen with the precursor of both androgenic and estrogenic effector molecules, dehydroepiandrosterone (DHEA). Both estrogens and DHEA dampen local inflammation and promote matrix deposition. The modulation of inflammatory responses by sex hormones is partially regulated by modulating macrophage function, which in turn leads to changes in TNF-alpha production, macrophage migration inhibitory factor secretion, and IL-6 expression.
  In contrast, androgens seem to be negative regulators for wound healing suggesting that they retard repair processes and enhance the local inflammatory response. All surgeons including those dealing with flaps used in reconstructive urology are confronted with impaired wound healing possibly resulting in chronic wound healing states. Topical and systemic estrogen treatment as well as dehydroepiandrosterone may help to overcome some of the problems of flap or other reconstructive interventions and its sometimes peculiar problems regarding healing. This may be of particular importance in elderly patients were particularly estrogen and DHEA deficiency is thought to be the cause of age-related impaired wound healing. One should also think about using systemic hormonal replacement therapy in female patients prior to complex reconstructive surgery in order to reduce chronic wound problems.

Dr. Karl-Dietrich Sievert &
Dr. Arnulf Stenzl
Department of Urology
Eberhard-Karls-University Tuebingen
Tuebingen, Germany