Slow-healing wounds may signal underlying disease
MedWire News: People with ulcers and other skin wounds that refuse to heal may be suffering from undiagnosed problems with their immune systems, suggests research.
The observations, which were reported by US scientists, may indicate that people with persistent wounds should be tested for immune-system diseases such as rheumatoid arthritis.
Dr Victoria Shanmugam (Georgetown University Hospital, Washington, District of Columbia, USA), who led the research team, said she hoped the findings would lead to a greater awareness among patients and general practitioners of the implications of slow would healing.
She said: "If a doctor has a patient with a leg ulcer that won't heal after 3 or 4 months and they have done all the appropriate treatments, I hope they will look for the presence of an autoimmune disorder."
The research was presented at the American College of Rheumatology Annual Scientific Meeting in Chicago, Illinois, and has been accepted for publication in the International Wound Journal.
Dr Shanmugam's team initiated the study after noticing that wound healing was particularly slow among patients who had autoimmune diseases. Such diseases can take many forms; examples include rheumatoid arthritis, systemic lupus erythematosus (also known as "lupus" or SLE), and psoriasis.
The researchers obtained and analyzed medical records of 340 patients who attended a Center for Wound Healing with an open wound - usually a leg ulcer - over a 3-month period during 2009. Patients were referred to the center because they had suffered from an open wound that hadn't healed after at least 3 months of normal therapy.
The study found that nearly one in four of these patients had an autoimmune disease. The most common condition was rheumatoid arthritis, accounting for nearly one-third of the patients. Other conditions included lupus, vasculopathy, scleroderma, vasculitis, seronegative arthritis, and inflammatory bowel disease.
Nearly half of the patients had diabetes mellitus, which is well-known to be linked with poor wound healing. Interestingly, one form of diabetes - Type 1 or juvenile-onset diabetes - is considered an autoimmune disorder.
Of note, patients with autoimmune diseases tended to have much larger, more painful wounds than their counterparts with healthy immune systems. Wounds in people with autoimmune diseases also took much longer to heal - 14.6 months, on average, compared with 10.3 months in other people.
The researchers conclude that their findings may provide important insights into the underlying causes of delayed wound healing, and say their next step will be to perform a large, 3-year study, which is being funded by the US federal government.
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By Joanna Lyford