6 Factors That Contribute to Slow Skin Healing

February 19, 2023

Reference Lab

FEB 19, 2023

Within the genetic backbone of our cells, the skin possesses an almost magical ability to heal itself. When skin is damaged, our body naturally triggers biological mechanisms and growth factors to promote skin regeneration. All the while immune cells survey the area to fight off infectious bacteria that could lead to diseases.

While this intrinsic superpower is something most of us possess naturally, it can be heavily influenced by the state of our health and lifestyle choices. It’s important to understand the internal and external factors that can either hinder or help skin healing in order to keep our body’s first defense, our skin, in optimal shape.

This blog will explore some reasons why wounds heal slowly, and the science behind why slow wound healing increases with age. It will also dive into the most common factors that contribute to slowed wound healing and provide recommendations to help speed up the process. Finally, this blog will describe what improper wound healing looks and feels like and what to do if a wound is healing slowly.

Why is my wound healing so slowly?

There could be several reasons behind your slow wound healing¹. Some possible causes include:

Poor nutrition

A diet lacking in protein, vitamins, and minerals can slow down the healing process. These nutrients are essential for the growth and repair of tissue, and a deficiency can impede the body's ability to heal.

Infection

A wound that becomes infected can significantly slow down the healing process. Signs of infection include redness, swelling, warmth, and pus or other drainages. These signs of infection often appear within a few hours or days due to the rapid replication of bacteria deep within the wound. If you suspect an infection, you should seek medical attention right away.

Underlying medical conditions

Conditions such as diabetes can impede blood flow to the wound and inhibit healing due to the negative effect of high blood sugar levels on blood vessels. Chronic diseases that compromise the immune system, such as heart-related conditions (coronary artery disease, peripheral vascular disease), cancer, and AIDS can also significantly compromise the wound-healing process.

Poor blood circulation

If blood flow to the wound is poor, the body may not be able to bring the necessary nutrients and oxygen to the site. The blood is also an important vehicle for immune cells that traverse the body in search of pathogens. To ensure optimal blood circulation, you should stay diligent at remaining hydrated and avoid diuretics.

Certain medications

Some medications, such as steroids, blood thinners, and immune-inhibiting biologics, can slow down the healing process. If you are taking any medications and are concerned about the slow healing of your wound, you should talk to your healthcare provider.

Age

As we age, our body's ability to heal can slow down. This is partly due to the loss of structural factors and moisture retention that occurs with age. Additionally, cellular senescence during aging can deplete skin tissue of restorative factors.

It's worth noting that some wounds take longer to heal than others, especially if the wound is deep or significant. Also, people with an underlying medical condition that affects the healing process may need to take extra precautions and steps to ensure proper and normal wound healing. If you are concerned about the slow healing of your wound, it is best to consult with a healthcare professional for an evaluation and proper treatment. They will be able to examine the wound and determine the cause of slow healing, as well as provide appropriate care.

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How long does it take for a wound to heal?

The amount of time it takes for a wound to heal can vary depending on several factors, such as the size and depth of the wound, the location of the wound, and the person's overall health. Minor wounds such as small cuts, scrapes, and burns may heal within a few days to a week. Larger or deeper wounds, like surgical incisions or pressure ulcers, may take several weeks or even months to heal. Deep wounds (such as puncture wounds) or a wound that is in an area with poor blood flow may also take several weeks or months to heal.

It's not uncommon for wounds to take longer to heal than what is typically expected, especially as you age. Some people may develop an underlying medical condition that affects the healing process, such as an autoimmune disorder, which can slow down the healing process unexpectedly. Additionally, older adults are more susceptible to slow wound healing.

How do you treat delayed wound healing?

Treatment for delayed wound healing depends on the underlying cause of the delay². Here are a few general treatment options:

Debridement: Dead or infected tissue can slow down the healing process. Debridement is the process of removing this tissue to allow healthy tissue to grow. This can be done through surgical, mechanical, or chemical means, and should always be done at the advice or care of a medical professional.
Topical treatments: Various topical therapies can be used to promote wound healing. These include creams and ointments that contain growth factors, antibiotics, vitamins (vitamin A, vitamin C), or other wound healing and/or cell renewal agents.
Wound dressings: Different types of dressings can be used to keep the wound clean and moist, which can promote healing. These can be something as simple as a bandage, or other advanced dressings such as hydrocolloid dressings, hydrogel dressings, and alginate dressings.
Nutrition: A diet that is high in protein, vitamins, and minerals can support the healing process. Your healthcare provider may recommend that you take supplements or make dietary changes to ensure that you are getting enough of these essential nutrients.
Surgery: In some severe cases, surgery may be needed to remove infected tissue or to close a large wound.
Physical therapy: In some cases, physical therapy may be recommended to help improve blood flow and reduce the risk of contractures.
Medications: Antibiotics may be prescribed if there is an infection. Pain medication can be prescribed when necessary.

Treatment for delayed wound healing may be a combination of these options and can be tailored to the individual's specific needs. If you have a wound that is not healing properly, it's important to seek medical attention as soon as possible. A healthcare professional can examine the wound, determine the cause, and provide appropriate recommendations for care.

What are the typical stages of wound healing?

Wound healing is a complex process that involves various cellular and molecular interactions, and disrupting factors can occur at any stage of the healing process³. There are four main stages of wound healing:

Hemostasis (begins within a few minutes/hours after injury): the process of stopping the bleeding by clotting factors at the site of injury.
Inflammation (begins immediately and lasts for a few days):< characterized by the accumulation of white blood cells to remove bacteria and debris and initiation of the repair process
Proliferation (begins a few days after injury and lasts for about 3-4 weeks): new blood vessels form, and the wound begins to close. The cells in the wound, such as fibroblasts and keratinocytes, begin to divide and migrate to the wound site, where they will produce new tissue.
Remodeling (begins several weeks after injury and can last for up to 2 years): the wound continues to mature, and the new tissue becomes stronger. This new, pink-tinted tissue is referred to as granulation tissue, which is composed of new fibroblasts, keratinocytes, endothelial cells, and new thin-walled capillaries. The scar tissue that forms during this stage is not as strong as the original tissue, but it will eventually become almost as strong.

What factors contribute to slowed wound healing?

Several factors can disrupt any of the four stages of wound healing. Certain genetic diseases that affect blood clotting (e.g., hemophilia, von Willebrand disease) or disrupt inflammatory pathways (e.g., atopic dermatitis, psoriasis, rosacea) can significantly decrease the rate of wound healing and remodeling. Other diseases that cause poor circulation, such as diabetes, can impede blood flow to the wound and increase the chances of infection⁴.

Knowing what foods to avoid during wound healing is essential as poor nutrition can affect the availability of the necessary building blocks to repair the wound⁵. Certain medications, such as steroids and biologics, can slow down the healing process by inhibiting the inflammatory response, which is essential for the wound healing process⁴. Age can also play a role in wound healing as the body's ability to repair itself may decline with age, which makes the elderly more susceptible to slow wound healing.

Lastly, the most important factor that can contribute to slow wound healing is insufficient care for the wound. Poor wound care increases the chances of infection and inflammation, leaves dead tissue to inhibit proliferation and remodeling, and can lead to chronic and deeper wounds. If you are concerned about the slow healing of your wound, it is best to consult with a healthcare professional for an evaluation and proper treatment.

Does the location of a wound impact the rate at which it heals?

The location of a wound can have an impact on the rate at which it heals. For example, wounds on the face and scalp tend to heal more quickly than wounds on the legs. This is because the blood flow to the head and face is typically greater than it is to the lower extremities. Additionally, the skin on the face is generally thinner and has a greater number of blood vessels, which can help to promote healing.

Wounds on the hands, feet, or joints may also take longer to heal because these areas have less flexibility and are more prone to movement which can make it more difficult for the wound to stay closed and heal. Areas that are exposed to friction, pressure, or shear forces may take longer to heal due to the constant movement.

Wounds that are in areas with poor blood flow may take longer to heal because the body has a harder time getting the necessary nutrients and oxygen to the wound bed. This can be the case with wounds on the legs, as well as in people who have peripheral artery disease or diabetic wounds.

When should I be concerned when a wound isn't healing?

You should be cautious if a wound isn't healing as quickly as you would expect or if it appears to be getting worse instead of better. A non-healing wound can be an indication of an underlying problem, such as infection or poor circulation. Here are a few signs that you should look out for:

The wound is becoming larger or deeper.
The wound is producing pus or other drainage.
The wound is becoming more painful or tender.
The wound is becoming red, warm, or swollen.
The wound is becoming itchy or has a foul odor.
The wound is not closing, or the edges are not coming together.
You have a local/systemic fever or other signs of wound infection⁶.

If you notice any of these signs, it's important to seek medical attention as soon as possible. A healthcare professional can examine the slow healing wound, determine the cause, and provide appropriate care. They may also perform diagnostic tests such as wound cultures or advanced imaging. In general, it's important to be vigilant about the healing of any wound and to seek medical attention if you notice any signs of delayed healing or complications.

How does age impact wound healing?

As we age, the body's ability to heal can slow down. A characteristic feature of older skin is the progressive loss of the primary structural and functional proteins in the skin: collagen and elastin. Collagen promotes skin firmness, while elastin provides skin rebound and elasticity, and these proteins work in concert to enable skin resilience and provide a fresh, smooth appearance.

As we age, the skin becomes thinner and less elastic due to the loss of these structural proteins, making it more fragile and more susceptible to injury. Additionally, the blood vessels in the skin become less efficient at delivering oxygen and nutrients to the wound, which can slow down the healing process. Age-related changes in the immune system can also make it harder for the body to fight off infections⁷. Using the right topical skin care products to support skin health like a peptide moisturizer, peptide body lotion, or gentle daily cleanser can help support and nurture the structural foundation of skin.

Older adults are more likely to have underlying health conditions, such as diabetes or circulatory diseases, which can also slow down the wound-healing process. They also have a higher risk of developing infections and pressure ulcers, which are difficult to heal and can cause serious complications.

It's important for older adults to be extra cautious about avoiding injuries, and to seek medical attention if they do sustain a wound. They should also be vigilant about monitoring wounds for signs of infection or other complications and seek medical attention if they notice any changes.

Conclusions:

Slow healing wounds can be due to many underlying causes, such as poor nutrition, infection, underlying medical conditions, poor blood circulation, and certain medications.
Healing time for a wound can vary based on wound size, location, and person's health. Minor wounds can heal within a few days to a week, while larger or deeper chronic wounds can take several weeks or months to heal.
Age significantly impacts the body’s ability to heal wounds in the skin due to the progressive loss of the primary structural and functional proteins.
Treatment options vary and depend on the underlying cause of delayed healing. Consult a healthcare professional for an evaluation and proper treatment.

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