What Do We Know About Corticosteroids and Wound Healing?

Background: The effects of corticosteroids on wound healing have important management implications. Objective: To review (1) normal wound healing and how corticosteroids impact the process, (2) data on the effects of corticosteroids on wound healing, and (3) dosing, chronicity, and timing of corticosteroid administration relative to surgery. Design: Literature review. Discussion: Corticosteroids affect all 3 phases of wound healing. Dexamethasone decreases cytokine expression and thereby decreases chemotactic and mitogenic stimulus for other inflammatory cells and also downregulates intercellular adhesion molecule 1 (ICAM-1) causing attenuated granulocyte adhesion and migration. High-dose steroids reduce macrophage wound infiltration. Steroids reduce transforming growth factor-β (TGF-β) levels and expression of keratinocyte growth factor attenuating fibroblast proliferation and impairing wound re-epithelialization. Steroids impair collagen turnover, disrupt dermal-epidermal junctiona more...