Ostomy Wound Management Options Examined

APRIL 25, 2017
Meghan Gagnon, PharmD candidate, University of Connecticut School of Pharmacy

Patients with wounds often take pharmacological agents for wound treatment or illness management. However, these medications can promote, impede, or even cause wounds or skin reactions.

Researchers from Rutgers University in Camden, New Jersey, have prepared a review of relevant wound healing literature. Published in the March 2007 issue of Ostomy Wound Management, it details the medications most likely to impair wound healing and damage skin integrity.

Among the agents of most concern are the anticoagulants, antimicrobials, anti-angiogenesis agents (bevacizumab, aflibercept), antineoplastic drugs, antirheumatoid drugs (methotrexate, aspirin/nonsteroidal anti-inflammatory drugs) colchicine, Dakin’s solution (sodium hypochlorite), nicotine, steroids, and vasoconstrictors.
Steroids and NSAIDs both have little impact with short term use, however long-term use can have severe negative impacts on wound healing.

Conversely, various drugs have the ability to assist wound repair. These include hemorrheologic agents, hormones, phenytoin, prostaglandins, zinc, and vitamins A and C. Literature reviews also support the use of certain natural products used topically to enhance wound repair. These include aloe vera, curcumin, ginger, medicinal (eg, Manuka) honey, mucilage (slippery elm), and witch hazel.

Prescription pharmacologic agents such as, calcium channel blockers, regular insulin, nitroglycerine, opioid-related drugs, phenytoin, retinoids, sildenafil, and sucralfate have been used off-label as topical therapies to aid wound healing.

In some instances, medication therapies themselves can create wounds or cause skin damage. Skin reactions are one of the most common adverse drug events. Almost all medication classes can cause or induce skin reactions, with ADE rates for some being as high as 5%.

The researchers included a variety of helpful tables in this review. Various tables address medications with reported and potential effects on wound healing, drugs rarely causing skin eruptions, and common drug offenders. Also included are figures displaying images of the various skin reactions (including possible offenders) for identification purposes. The pictures in particular can be very helpful to practicing pharmacists.
With a vast knowledge of the mechanisms, effects, and interactions of pharmacologic agents and natural products, pharmacists can play a key role in ensuring comfortable and timely wound healing.
Beitz JM. Pharmacologic impact (Aka "Breaking Bad") of medications on wound healing and wound development: A literature-based overview. Ostomy Wound Manage. 2017 Mar;63(3):18-35.

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