Medications that inhibit ulcer and wound healing

A number of commonly prescribed medications can delay wound healing. The mechanisms for this vary and can be dose-related. Mechanisms include:

• inhibition of growth factor or cytokines (eg corticosteroids, colchicine)
• destruction of replicating cells (eg antineoplastic drugs, leflunomide)
• causing oedema.

Some medications can cause wounds. Hydroxcarbamide (hydroxyurea) is associated with ulcer formation (usually on the tips of the malleoli), via dermal atrophy and the formation of microthrombi. Warfarin can cause skin necrosis. Nicorandil can cause dose-dependent skin ulceration, which generally resolves when the medication is stopped.

If possible, stop the causative medication or reduce its dose. Before adjusting medication, consider the severity of the underlying condition and the need to taper doses (eg corticosteroids). If stopping the medication poses an unacceptable risk to the patient so wound healing is unlikely, the goal of wound management may need to change (see Ulcers or wounds not expected to heal). If the medication profile changes and wound healing becomes possible, revert to a curative goal.