Anabolic steroids and wound healing
My goal in writing the editorials that appear in this journal is to address contemporary issues of interest to the journal’s constituencies. Toward that end, I have made it my responsibility to keep abreast of the skin and wound care literature and other advances in the field. In particular, I am interested in news of novel treatments, prevention strategies, and monitoring techniques that could be used to improve the management of pressure ulcers and other chronic, nonhealing wounds. In my most recent editorials, I have discussed a few novel therapies for the treatment of chronic wounds, including growth factors and artificial skin.
These new therapies, however, are not all that is “new” in wound management. Treatment strategies traditionally used in other areas of medicine may offer us new alternatives for the old problem of managing chronic wounds. It will be to our advantage-and to our patients’ benefit-to learn from other treatment models, to extrapolate information about the natural course of clinical problems and treatments, and to apply what we have learned to the management of patients who are at risk for chronic wounds.
Anabolic Steroids Revisited
One such treatment strategy that bears consideration is the use of anabolic steroids. Anabolic steroids were approved by the Food and Drug Administration in the 1960s for the treatment of weight loss due to extensive surgery, chronic infections, severe trauma, failure to gain or maintain normal weight (failure to thrive) without definite pathophysiologic reasons, or protein catabolism due to prolonged corticosteroid administration. More recently, anabolic steroids have been used to treat the wasting syndrome associated with HIV- and AIDS-related conditions.1
How does this apply to the management of chronic wounds? Consider elderly and debilitated patients. Among the intrinsic and extrinsic factors that place them at risk for pressure ulcers are malnutrition, loss of lean body mass, cachexia, and wasting. These factors also are associated with poor or prolonged healing of acute and chronic wounds. Clinical researchers have begun to explore the use of anabolic steroids in patients with wounds to treat manifestations associated with malnutrition, loss of lean body mass, and wasting syndromes, and this work has recently been the topic of pilot studies and presentations at national meetings.2
Research on Anabolic Steroids
Exploring the clinical utility of anabolic steroids for treatment of conditions related to chronic wounds is intriguing. Anabolic steroids have recently been used for the adjunct treatment of bums.3 Pressure ulcers have been compared with bum models in which the injury in both the acute and chronic phases increases metabolic demands, leading to a catabolic state.4 Anabolic steroid therapy combined with increased protein intake has been successful in promoting weight gain, reversing catabolism, and increasing the rate of wound closure. Animal models also are providing some evidence that anabolic steroid use may aid in the healing of experimentally derived muscle contusion and injury, as demonstrated by the speed of the recovery of force-generating capacity of skeletal muscle.5
Recently, a paper presented at a national conference discussed the use of oxandrolone (Oxandrin; Bio-Technology General Corporation, Iselin, NJ) in the treatment of chronic, recalcitrant pressure ulcers in patients with spinal cord injury. Future doubleblind, placebo-controlled trials are in order to further test the effects of treatment of pressure ulcers with anabolic steroids.
Although anabolic steroids have been around for over 30 years, they have been considered out of the mainstream of treatment options. Misuse by bodybuilders and athletes, as reported in the lay press, has given anabolic steroids a bad reputation, and practitioners who prescribed them were often suspect and on the fringes. Renewed interest in the legitimate use of anabolic steroids could rehabilitate that image and provide us with another option for managing our patients with chronic wounds.
1. Coodley GO, Loveless MO, Merrill TM. The HIV wasting syndrom: a review. J Acquir Immune Defic Syndr 1994;7:681-94.
2. Spungen AM. Rasul M, Koehler KM, Cytryn AS, Bauman WA. Effect of anabolic steroid therapy on healing of long-standing pressure ulcers: nine case reports in patients with spinal cord injury. Presented at the American Spinal Injury Assocation meeting, Atlanta, GA, April 1999.
3. Demling RH, DeSanti L. Oxandrolone, an anabolic steroid, significantly increases the rate of weight gain in the recover phase after major bums. J Trauma 1997;43:47-51.
4. Demling RH, DeSanti L. Involuntary weight loss and the nonhealing wound: the role of anabolic agents. Adv Wound Care 1999;12(Suppl 1): 1-14.
5. Beiner JM, Joki P, Cholewicki J, Panjabi MM. The effect of anabolic steroids and corticosteroids on healing of muscle contusion injury. Am J Sports Med 1999;27:2-9.
Richard “Sal” Salcido, MD, is the Editor-in-Chief of Advances in Wound Care. He is Professor and Chairman of the Department of Rehabilitation Medicine at the University of Pennsylvania Health System, Philadelphia, PA.
Copyright Springhouse Corporation Oct 1999
Provided by ProQuest Information and Learning Company. All rights Reserved