Leg ulcers can take months to treat, but female hormone cream is speeding up the healing process
02:17 GMT, 2 October 2012
Oestrogen has an effect on a range of different cells within a wound
Doctors have discovered why wounds such as ulcers take longer to heal in older people — and they believe a cream containing the female hormone oestrogen could be the answer.
About 200,000 people in the UK — many of them over 65 — have an open wound such as an ulcer or pressure sore that fails to heal, a problem which costs the NHS up to £3 billion a year.
Diabetics, the elderly and people with nerve damage or circulatory problems are particularly at risk.
Not only are these wounds painful and
debilitating — taking months to heal or, in some cases, never healing —
they also leave people exposed to potentially life-threatening
infections because there is no barrier preventing bacteria entering the
research shows that patients who develop a non-healing wound end up
staying in hospital three times longer than they should.
Until now, it has been poorly understood why some wounds take a long time to heal.
It’s thought it is because cells are not co-ordinating properly to
allow tissue to heal, although the precise mechanism is not known.
This means current treatments — including dressings and even the use of maggots to clean wounds — are largely ineffective.
For some, the only solution is amputation.
researchers at the University of Manchester have discovered that the
female hormone oestrogen — which is naturally present in both men and
women — plays a key role in wound healing.
levels decline in both men and women as they get older as part of the
natural ageing process: in women after the menopause while men
experience a gradual fall from their 20s.
Falling oestrogen levels are known to age the skin, reducing elasticity and altering the body’s response to inflammation.
Laboratory tests have now shown that oestrogen has an effect on a range of different cells within a wound.
The research involved taking tissue samples from young and older men and looking for differences in the genes involved in the body’s healing process.
Scientists found the main variations were in genes affected by oestrogen.
The differences in the genes were ‘very strong’ between the young and older men, explains Dr Matthew Hardman, a senior research fellow from the University of Manchester’s Healing Foundation Centre who made the breakthrough.
Current treatments for leg uclers – including dressings and even the use of maggots to clean wounds – are largely ineffective
In other words, the natural fall in oestrogen levels that occurs with age is the reason wounds don’t heal as well in older people. This led to the conclusion that if older people could be given oestrogen, their bodies would heal better.
Dr Hardman says: ‘We knew that oestrogen was important in healing, but we didn’t realise it played such a pivotal role.
Our discovery could lead to a new treatment for people with non-healing wounds.
This could make a huge difference to their lives, as these wounds are not only painful but cause immobility and social isolation.’
However, it is not possible to simply give patients oestrogen because of its side-effects, including an increased risk of cancer, he adds.
‘So we have been developing and testing treatment options using compounds similar to oestrogen but without the side-effects that come with it.’
Breast cancer drug Tamoxifen, which is similar in structure to oestrogen, has been identified as a possible treatment for non-healing wounds by the researchers.
After successfully turning the drug into a cream that can be applied to an open wound, they are about to test it on 30 volunteers over the age of 65.
They will receive two small skin cuts, one treated with the Tamoxifen cream and the other with a placebo.
If the trial is successful, the cream will then be tested on a larger group of patients with chronic wounds and could be widely available in five years’ time, says Dr Hardman.
Professor James Goodwin, head of research at Age UK, which has funded the research, says: ‘There are limited treatment options for chronic wounds despite many thousands of people aged 65 and over suffering terrible pain and discomfort for months, even years, with wounds that won’t heal.
‘This research could make a huge difference to hundreds of thousands of lives and help save the NHS some much needed funds.’
Meanwhile, researchers have been testing the benefits of algae for slowing down the effects of ageing.
A study published in the journal Actia Biochmica Polonica shows that an antioxidant harvested from sea algae may improve skin elasticity and moisture content.
In one trial, conducted in Japan, 30 women with dry skin were given a 6mg daily oral supplement and a rub-on solution.
After eight weeks there were significant improvements in moisture content of the outer skin layer.
In another trial with 36 men, moisture content and sebum oil level in the cheeks improved after six weeks.
It’s thought the benefits may be due to the antioxidant astaxanthin, also found in fish and seafood (it provides the red colour of salmon).
This may help protect the outer layers of the skin against free radical cell damage.