Steroids, retinoids, and wound healing

Glucocorticoids (corticosteroids) cause dehiscence of surgical incisions, increased risk of wound infection, and delayed healing of open wounds. They produce these effects by interfering with inflammation, fibroblast proliferation, collagen synthesis and degradation, deposition of connective tissue ground substances, angiogenesis, wound contraction, and re-epithelialization. These actions are mediated by the antagonism of various growth factors and cytokines. Vitamin A restores the inflammatory response and promotes epithelialization and the synthesis of collagen and ground substances. However, vitamin A does not reverse the detrimental effects of glucocorticoids on wound contraction and infection. In this paper, the known mechanisms of the interaction of glucocorticoids and retinoids are reviewed. The mutually inhibitory interplay between glucocorticoids and retinoids may serve to regulate the processes of inflammation, immunity, and connective tissue repair.