The Use of Topical Corticosteroid Treatments to Modulate the Inflammatory Response and Improve Wound Healing - A Case Study

Abstract Body: Introduction: Steroid use in wound healing has always been discouraged, and said to cause delayed wound healing. Can the anti-inflammatory effects of topical steroid usage help in wound healing when used in tandem with an enzymatic debriding agent? A Case Report: A 62 year old diabetic male presents with a left foot plantar ulcer which has been present for 3 weeks. Initial treatment included local wound care, an antibiotic course, limited weightbearing, and serial debridements.  The wound got smaller, however, hypergranular tissue became a challenge, impeding the wound edges' ability to contract. To address the hypergranular tissue a topical steroid* was applied to the wound base, alternating the following day with an enzymatic debriding agent+ and continuing the alternating treatments for a week. On follow-up, the hypergranular tissue was no longer present and the wound edges were found to have no maceration present, no undermining, and no epibole. Wound measurement graphs depict the consistent reduction of size and depth of the wound with this alternating protocol over time.  Conclusion: The author appreciates that the anti-inflammatory effects of topical steroid used in tandem with an enzymatic debridement agent can help to address hypergranular tissue and ultimately improve contraction of the wound edges, thus bringing the wound to closure in a shorter period of time. Instead of completely denouncing and avoiding the use of steroids in wound healing, a paradigm shift may be on the horizon in the field of wound care. If the delicate balance of decreasing hypergraular tissue while promoting granulation can be achieved, as we modulate the body's inflammatory parameters we may be able to proceed through the stages of wound healing faster.