Why are my wounds healing more slowly?

Dear Reader,

Stress, nutritional deficiencies, and many other factors can cause slow wound healing and scarring. Based on what you’ve written, it’s hard to tell whether your raised scars are hypertrophic scars (HTS) or keloids. Unlike HTS, keloids tend to grow beyond the boundaries of the old wound. If you’re concerned about your wounds and scars, speaking with a health care provider may help. They can help to determine whether your wounds are infected and provide treatment if needed.  

How do wounds heal?

When you get a cut, platelets in your bloodstream clump together, creating a plug that stops the bleeding. Then, clotting proteins spin a net that holds the blood clot together.  

Once the blood clot is formed, blood flow increases to the wound area. Antibodies, white blood cells, and other nutrients arrive to fight off harmful bacteria and prevent infection. This process is known as inflammation.  

Around five days after the injury, skin cells gather at the site of injury. They start to make collage—a type of protein that’s found in skin and muscles. Collagen serves as scaffolding for scar tissue to fill in the wound. Over time, scar tissue becomes less thick and smoothens out.  

What can cause raised scars?

Raised scars, also called hypertrophic scars (HTS), happen when the body makes too much collagen during the healing process. They may be red in color, shiny, itchy, painful, or restrict motion when located above a joint. HTS are different from keloids, another type of raised scar. While HTS tend to be located within the wound's boundaries, keloids grow beyond the margins of the old wound.  

Some things can increase your risk of developing HTS. These include:  

• Age: HTS are more common in younger people under the age of 30. 
• Allergies: People with allergies are more likely to develop HTS. This is because the cells responsible for allergic reactions also stimulate collagen production. 
• Infection: Bacterial toxins can prolong inflammation, leading to HTS. 
• Skin stretching: HTS are more common where skin is taut, such as the joints. 

What can cause slow wound healing? 

Many things can delay or change how wounds heal. Some of these include:  

• Psychological stress: When you experience short-term, long-term, or traumatic stress, your body releases cortisol. Cortisol is a hormone which suppresses inflammation when it’s released quickly. However, if it’s released chronically, it can increase inflammation. This can disrupt the body’s immune response and delay the healing process. 
• Poor sleep: When you sleep, your body releases growth factors that enhance cell growth and repair. Poor sleep quality can negatively affect wound healing and muscle repair. 
• Age: With age, the body’s inflammatory response slows down. This causes the healing process to take longer. 
• Type 2 diabetes: High blood sugar levels can lead to chronic inflammation. It can also weaken the immune system. These make it harder for the body to heal and fight off infection. Additionally, diabetes can cause complications like poor circulation. This limits blood flow to the wound area, reducing the supply of oxygen, nutrients, and repair cells needed for healing. 
• Obesity: Excess fat can cause poor blood circulation. This makes it harder to deliver oxygen and other cells to the wound area, slowing down the healing process and increasing the risk of infection. 
• Protein deficiency: Without enough protein, the body can’t make as much collagen, antibodies, and growth factors as it needs to heal. 
• Medications: Non-steroidal anti-inflammatory drugs (NSAIDS) may suppress the body’s inflammatory response and slow down the growth of new tissue. This can cause scarring. 
• Smoking: Cigarettes and other tobacco products contain nicotine, a highly addictive drug. Nicotine can damage blood vessels, suppress the immune system, and decrease oxygen levels in your blood. This can delay wound healing and increase the risk of infection. Smoking may also slow collagen production, which can weaken scar tissue. 
• Alcohol: Alcohol can suppress the inflammatory and immune responses needed to kickstart the healing process and fight infection. 

How can you help wounds heal?

Keeping wounds clean and covered with a bandage helps to prevent infection. Antibacterial ointments and dressings can also create a moist environment for healing. Moisture promotes skin cell growth and may help to reduce scarring. Once the scab has formed, it’s best to avoid scratching or picking at it. If it itches, you can apply lotion to relieve discomfort.

Wounds that don’t heal or heal slowly may be a sign of infection. Other common signs of infection include redness, swelling, warmth, pain, and oozing pus or liquid. It’s recommended to speak with a health care provider if you experience these symptoms. They may be able to identify any underlying health conditions, provide treatment, and help you get back into tip-top shape.  

Happy healing!