The effects of stress on wound healing and leg ulceration

Stress is a universal phenomenon, which has been the focus of much investigation over the past five decades. Much has been discovered about the physiological responses to stress. This review examines the concept of stress in relation to its effect on wound healing. An online literature search was carried out using the databases Medline, Cinahl and Pubmed and the key words stress and wound healing, and stress and leg ulceration. The rationale for specifically examining leg ulceration resulted from the author's interest in this wound type and also the volume of associated literature on the topic published to date. Stress has been demonstrated to have an adverse effect on a variety of natural resistance responses and specific immunological modifications in animal and man alike, causing, for example, reduced inflammatory response, susceptibility to infection and decreased cytokine production (Cohen et al, 1988; Sheridan et al, 1991). Stress and its effects on growth factor regulation have led theorists to examine whether stress adversely affects wound healing (Glaser et al, 1999). Much of the research as examined acute wounds, although causal inferences may be drawn from the wealth of qualitative research examining the effects of venous ulceration. To date, very little has been conducted in the relatively new area of stress and wound healing. Further investigations are required to prove that stress elicits an immunological response affecting the biological markers of wound healing and thus validates the theory that stress may have a negative impact on healing itself. Causal relationships may be postulated between stress and healing in leg ulceration.