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leg ulcers


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.

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 body.

Furthermore, 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.

Now British 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.

Oestrogen 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.

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. Matthew Hardman says: “We knew that oestrogen was important in healing, but we didn’t realize 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. Matthew Hardman.

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 color of salmon).

This may help protect the outer layers of the skin against free radical cell damage.



According to US and Canadian researchers, a “spray-on skin” developed by Healthpoint Biotherapeutics in the US, which coats a wound with a layer of skin cells, could help healing leg ulcers.

The spray was tested on 228 people with leg ulcers, which are painful open wounds that can last for months.

The findings, published in the Lancet, showed that ulcers treated with the spray were more likely to heal and did so more quickly.

Experts said faster healing could save money despite the cost of the spray.

Leg ulcers are hard to treat. The best treatment, compression bandages, will heal only about 70% of ulcers after six months. Other options include taking skin from somewhere else on the body and grafting it over the wound.

Instead the spray puts a coating of donated skin cells and blood-clotting proteins over the ulcer.

A "spray-on skin" developed by Healthpoint Biotherapeutics, which coats a wound with a layer of skin cells, could help healing leg ulcers

A "spray-on skin" developed by Healthpoint Biotherapeutics, which coats a wound with a layer of skin cells, could help healing leg ulcers

In the study, patients who were given the spray-on-skin every 14 days showed the most improvement.

The researchers said the size of the wound “began to decrease rapidly” as soon as the treatment started. In the patients who had the spray, 70% were healed after three months compared with 46% who received other treatment.

The spray was developed by Healthpoint Biotherapeutics in the US, which also funded the research.

One of the scientists involved, Dr. Herbert Slade, said: “The treatment we tested in this study has the potential to vastly improve recovery times and overall recovery from leg ulcers, without the need for a skin graft.

“This means not only that the patient doesn’t acquire a new wound where the graft is taken from, but also that the spray-on solution can be available as soon as required – skin grafts take a certain amount of time to prepare, which exposes the patient to further discomfort and risk of infection.”

The study largely tested the safety of the spray and the best dose to use, further studies will decide if it is a practical treatment for leg ulcers.

Leg ulcers are most commonly caused by high blood pressure in the veins of the legs which damage the skin, causing it to break down and develop into an open wound.