Improving Elderly Wound Healing

It is estimated that elderly wound healing results in U.S. annual heath care costs of over $15 billion.

Since the proportion of elderly individuals in the general population is increasing dramatically, with the number of adults 65 years or older projected to almost double (from 35 million to 53 million) by the year 2030, improving elderly wound healing is a heath care priority.

Studies have indicated that healthy individuals over the age of 65 years frequently have delayed wound healing. It is also common for individuals over 65 years to have several comorbidities that lead to impaired wound healing, such as peripheral arterial disease, obesity or cancer. In fact, U.S. Wound Registry data suggest that patients in outpatient wound centers have an average of six comorbidities including renal failure, peripheral vascular disease, diabetes and malnutrition.

Promoting Wound Healing

Wound healing involves 4 critical phases that overlap: the coagulation phase, the inflammatory phase, the migration-proliferation phase (development of granulation tissue), and the remodeling-regeneration phase that includes maturation, scar formation and re-epithelialization.

Age-related changes are apparent in all phases of wound repair and the disruption of any step in the wound healing process can lead to a delay in healing by 20-60%. Various factors associated with aging can affect wound healing including the decline of sex hormones, psychological stress, medications, neuropathy, immobilization, impaired cognitive function, poor hydration, compromised immunity, decreased skin antioxidants and increased oxidative stress.

Viniferamine® skin and wound care products include various nutrients that counteract oxidative stress including the important small molecule polyphenols oleuropein, resveratrol, and epigallocatechin-3-gallate (EGCG) from olives, grapes, and green tea, respectively, as well as L-carnosine, melatonin, and L-glutathione.

In addition, evidence indicates that many of these ingredients promote wound healing including oleuropein, which was shown to improve wound healing in an aging model. Resveratrol has been shown to improve wound healing in individuals with type 2 diabetes. EGCG was found to accelerate keratinocyte differentiation and wound healing, and melatonin was shown to accelerate the process of wound repair in full-thickness incisional wounds. Moreover, L-carnosine was found to stimulate wound healing in an incision wound model and L-glutathione was shown to be beneficial for ischemic wound healing. Furthermore, Centella asiatica and one of its main components, asiaticoside have important wound healing activities, and dipotassium glycyrrhizate is known to protect hyaluronic acid, which plays an important role in wound healing.

Maintaining Skin Homeostasis and Decreasing Infections

Psychological, emotional or psychosocial stress can lead to skin problems and impaired wound healing caused by the effects of the stress hormone, cortisol on skin homeostasis and keratinocyte proliferation.

Protecting the normal skin microbiome (community of microbes) can help maintain skin homeostasis.Viniferamine^® skin and wound care products are pH balanced and correspond with the normal chemistry of skin to help preserve the normal skin microbiome. Certain medications can also interfere with wound healing such as systemic glucocorticoid steroids including those used in treating rheumatoid arthritis, chemotherapeutic drugs, anticoagulants, non-steroidal anti-inflammatory drugs and pain medication including morphine.

Systemic glucocorticoids inhibit wound repair by suppressing fibroblast proliferation and collagen synthesis. Chemotherapeutic drugs delay skin cell migration and impair skin cell proliferation, as well as reduce angiogenesis and extracellular matrix (ECM) formation. They can also weaken the immune system and increase the risk of infection and biofilm (aggregates of microorganisms enclosed in a protective matrix) formation.

Several of the ingredients found in the products have antimicrobial effects including against biofilms. Resveratrol has been reported to inhibit methicillin-resistant Staphylococcus aureus (MRSA) biofilms. EGCG was shown to have antimicrobial effects against Pseudomonas aeruginosa (P. aeruginosa) and Staphylococcus aureus (S. aureus) that included activities against biofilm formation. EGCG has been shown to disrupt the communication signaling required for Eschericia coli (E. coli) to form biofilms. Oleuropein has been shown to inhibit the growth of several bacterial strains including S. aureus. Another important natural antioxidant included in the products, melatonin has antimicrobial effects against MRSA and antibiotic resistant P. aeruginosa.

In addition, Viniferamine® Silicone Barrier contains chlorhexidine digluconate that has been shown to prevent wound contamination. Chlorhexidine digluconate was found to be effective against vancomycin-resistant Enterococcus faecium (VREF) and has been used to cleanse patients in a medical intensive care unit. Moreover chlorhexidine digluconate has been found effective against Streptococcus epidermidis including in biofilms. Silicone Barrier can provide a second “breathable” skin that normalizes the barrier function allowing skin to heal.

Increasing Skin Barrier Function

Aging skin and the elderly are susceptible to xerosis (chronic dry skin), skin tears, senile purpura (fragile skin bruising) and moisture-associated skin damage (MASD) often related to incontinence-associated dermatitis (IAD). Viniferamine® SkinMineralZ can help decrease MASD and IAD. SkinMineralZ is a blend of three French mineral-rich clays that deliver vital nutrients to restore and detoxify skin. Strengthening the skin barrier helps prevent wounds and decreases the risk of minor wounds becoming exacerbated. Measuring transepidermal water loss (TEWL) is a way to assess the quality of the skin barrier and how well it functions. Oleuropein has been shown to reduce TEWL indicating its ability to increase skin barrier function. Evidence also demonstrates that melatonin has a stimulatory role in building and maintaining the epidermal barrier.

The proper balance of ceramides, cholesterol and fatty acids are also important for maintaining the barrier function. Scientific studies have shown that niacinamide (nicotinamide), found in Viniferamine® skin and wound care products including Silicone Barrier and SkinMineralZ, can increase the biosynthesis of ceramides as well as other lipids and improve the epidermal barrier. Interestingly, ceramides generated during skin barrier stress stimulate antimicrobial peptide (AMP) production to help protect the skin. Resveratrol also stimulates AMP production, leading to enhanced antimicrobial defense against skin pathogens and potential infections.

It’s good to know that Viniferamine® skin and wound care products can help improve wound healing in the elderly by decreasing oxidative stress, improving skin the skin barrier function and homeostasis, decreasing the risk of infections and decreasing moisture-associated skin damage.

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About the author: Nancy Ray, PhD is the Science Officer at McCord Research. Dr. Ray received her PhD in Biochemistry and Biophysics and was a postdoctoral fellow at NIH, Harvard University and Dana-Farber Cancer Institute, and the University of Iowa. She also earned bachelor of science degrees in Chemistry and Microbiology.

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