The Effects of Corticosteroids on Wound Healing - Essay Sample

Introduction

A wound is an injury to cells or living tissue that leads to the breakage of the skin or any epithelium that covers an organ only or together with the connective tissue. It is mostly caused by a cut, accidental or in surgery or from a disease that destroys these tissues. Wound healing can, therefore, be defined as the replacement of the injured tissue with another living tissue or with a connective tissue which can be through regeneration or repair.

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The process of wound healing requires inflammation to take place. Therefore, corticosteroids which are anti-inflammatory agents interfere with it on different stages. These stages are the hemostasis, inflammatory, proliferative, and maturation stages. The hemostasis stage and inflammatory stage often overlap and are characterized by swelling, exudation, pain, and heat. It is because of the inflammation process taking place at the initial stages of wound healing. During this stage, the injured cells release cytokines which are messengers that increase the number of circulating lymphocyte receptors. Histamine, serotonin, and kinins are produced during this stage as inflammatory mediators. In this stage, corticosteroids inhibit the synthesis of these inflammatory mediators by blocking the phospholipase A2 enzyme from converting membrane phospholipids to arachidonic acids. (Fauci 1996, 304-315)

The proliferative stage of wound healing is the second process that takes place after neutrophils have cleared the products of the inflammatory phase. In this stage, more macrophages have been attracted to the site of the wound. These macrophages are fibroblasts which secrete collagen type III. Collagen secretion occurs together with angiogenesis a process which involves the development of new blood vessels for about three weeks. In this stage, corticosteroids affect macrophages by preventing its migration. Moreover, corticosteroids inhibit the process of chemotaxis, synthesis of lysosome enzymes, and stabilize lysosome's membrane, therefore, preventing the production of lysosome enzymes in white blood cells.

The final stage is the maturation phase which has the role of strengthening the wound. It occurs by conversion of collagen III to collagen I which has 80% tensile strength of healthy tissue. It takes up to nine to twelve months for the wound to be completely healed. In this stage, corticosteroids affect the process of wound healing by enhancing collagen degradation. Therefore, corticosteroids inhibit contraction and epithelialization which is fundamental in the maturation phase.

Corticosteroids belong to a collection of natural and artificial compounds, analogs of hormones that are secreted by hypothalamic-anterior pituitary-adrenocortical axis, also referred to as adrenal gland. Corticosteroids get secreted in the adrenal cortex usually located alongside the adrenal glands. It comprises of three zones. The zona glomerulosa is involved in secretion of aldosterone, mineralocorticoid which plays a part in salt, water, and potassium uptake within the body. The middle zone (zona fasciculata) is responsible for the secretion of glucocorticoids. The inner region (zona reticularis) is responsible for the secretion of androgens.

In this case, corticosteroids are grouped into two broad categories including the natural and synthetic corticosteroids. They are also referred to as steroids. They function by decreasing swelling and reduction in the activity of the immune system. Inflammation relates to the method within which the body produces white blood cells and chemicals to shield the body against infectious agents like bacterium and viruses. However, in certain disease conditions, the body's defense system may fail to function appropriately. It may cause swelling to act against its soft tissues and thus causing cell injury (Ramamoorthy 2016, 15-31). The most prominent marks of inflammation include redness of the skin and swelling.

Corticosteroids lower the assembly of chemicals that cause swelling and soreness keeping the skin destruction in lower levels as possible. They are used in the treatment of several disorders in which the body's immune system fails especially in instances where inflammation may threaten to damage critical body organs. For example, corticosteroids can avert the deterioration of kidney inflammation which when not treated may lead to kidney failure. Corticosteroids are grouped into two broad categories that include natural steroids and synthetic steroids.

Corticosteroids are grouped into two major groups that are the glucocorticoids and mineralocorticoids. The glucocorticoid belongs to a group of corticosteroids that are characterized by their capacity to bind to glucocorticoid receptors and as a result trigger anti-inflammatory effects. They have specific receptors that help distinguish them from sex steroids and mineralocorticoids. Some glucocorticoids the likes of cortisol regulate carbohydrates, protein and fat breakdown and act as anti-inflammatories through inhibiting the release of phospholipids, lowering the action of eosinophil and other mechanisms. Cortisol is regarded as one of the most important glucocorticoids in the human body.

Mineralocorticoid belongs to a category of steroids characterized by their shut similarities to mineralocorticoid and their ability to influence salt and water balance. Mineralocorticoid is the associate example of a corticoid. It aids in dominant solution and water levels by promoting retention of metal within the urinary organ that is the kidney.

The artificial corticosteroids mimic the activity of naturally created corticosteroids and thus employed in persons with adrenal glands that manufacture low amounts of corticosteroids. They're applied in higher doses over replacement doses to treat diseases of immunity, inflammation or salt and water balance. Artificial corticosteroids are classified as their technique of use. The classification could embrace topical steroids, indrawn steroids and therefore the general sort of steroids. The topical corticosteroids are smeared on the skin, used on eyes through dropping and mucous membranes through inhalation. They occur in a range of formulations and potency which makes them flexible in treating different groups of people, different anatomic sites and various stages of the disease. There are different potency levels of topical steroids.

They can be mild, moderate, potent and very potent corticosteroids. The mild corticosteroids are essential during the management of mild inflammations of the skin such as insect bites and dermatitis. Moderate topical corticosteroids treat more severe cases of skin inflammation such as atopic eczema. The potent corticosteroids treat stubborn skin conditions and plaque psoriasis. Very potent topical corticosteroids are used for stubborn skin conditions that may fail to respond to the other forms of treatment. The potency of the drugs may vary depending on the concentration and formulations of the drug. The most effective medication to reduce inflammation is one that contains the highest strength.

Topical steroids are useful for treating skin conditions mainly those characterized by inflammation, hyperproliferation and immunologic involvement. They are widely used in the treatment of the vesicle-erosive diseases of the oral mucosa as they effectively control pain and swelling (Kwatra 2018, 11-22).Inhaled steroids are corticosteroids used to suppress inflammation by mainly switching off activated inflammatory genes. Systemic corticosteroids are steroids taken orally though mouth or administered through injection. The examples of oral forms of corticosteroids that are taken orally include prednisone and prednisolone. The injectable forms are administered either intravenously or parenteral routes that involve piercing the mucous membrane or skin (Min 2015, 749-755).

The wound healing phase that is most affected by corticosteroids is the inflammatory stage. The steroids that affect this stage are the glucocorticoids because they inhibit inflammation. It is the stage that occurs immediately after the injury to the cells or tissues. The function of this stage concerning wound healing is opsonization as well as leukocyte stimulation. The inflammatory process is fundamental in wound healing as it is the critical process through which the wound gets surplus nutrients to use in proliferation and maturation and also the transport of essential biomolecules that are fundamental for the healing process to the site of injury.

In case the inflammatory process in wound healing is inhibited, the wound would take longer to heal or fail to heal at all. It is because the inflammatory process leads to dilation of blood vessels to cause redness and warmth at the site of injury. Increased blood flow to the location of the damage is essential because it concentrates nutrients, leukocytes, antibodies, enzymes, and growth factors at the site of injury. These elements promote good healing process because they ensure that the cells around the wound regenerate rapidly and are not exposed to pathogens.

Also, the process leads to increased permeability of the cells around the wound leading to flow of protein-rich fluids into the extracellular space from intracellular space causing swelling. The exudation of the fluid is fundamental to keep the wound moist and prevent it from drying. Moreover, the protein-rich fluid contains granulation elements and essential proteins for proliferation.

The loss of fluid from the vessel by exudation leads to stasis. Stasis is a situation where the speed of blood flow is decreased by the concentration of red blood cells in vasodilated blood vessels. It is crucial since it ensures that the blood pressure at the site of the wound is low and does not break the developing epithelial lining and blood vessels.

Finally, there is adhesion of leukocytes to the epithelial lining of the injured vessels. It is accompanied by rolling and migration of other white blood cells leading to the accumulation of inflammatory cells such as macrophages and other leukocytes like neutrophils, lymphocytes, phagocytes, and eosinophil. These cells promote proliferation of the injured tissue and protection of the wound from pathogens and other disease-causing organisms. Also, the phagocytes engulf the damaged tissue debris to allow the process of proliferation and regeneration in wound healing to take place. (Fauci 1996, 304-315)

Different mediators of inflammation from the cells and plasma are used in promoting wound healing processes. The cellular derivative mediators are histamine, and serotonin which are derived from storage vesicles because they are pre-formed. Histamine is synthesized in the mast cells, basophils, and platelets whereas serotonin is made in the platelets only. Also, there are some mediators of inflammation that are newly synthesized by the cells after injury and include; prostaglandins, leukotriene, platelet-activating factor, and reactive oxygen species from leukocytes and mast cells except for platelet -activating factor that is derived from leukocytes and endothelial cells.

Other mediators are produced by macrophages and include nitric oxide, cytokines, and neuropeptides from leukocytes and nerve fibers. The inflammatory mediators from plasma are and C3a and C5a), C3b, as well as membrane attack complexes whose role is in complement activation to initiate homeostasis after injury. Also, bradykinins and coagulation factors are plasma mediators of inflammation.

The corticosteroid inhibits the inflammatory process by inhibiting the synthesis of prostaglandins, and leukotriene. Also, it stabilizes vesicles that contain serotonin and histamine, therefore, preventing their release to initiate the inflammation process. Steroids inhibit release...