Estrogen deficiency - a central paradigm in age-related impaired healing?

Burns and Trauma Branch of Chinese Geriatrics Society. [Expert consensus on systematic assessment and treatment of refractory wounds in the elderly (2025 edition)]

Early prevention and standardized management of refractory wounds in the elderly are very important for improving prognosis, reducing disability rate, and improving the quality of life of patients. For the diagnosis and treatment of refractory wounds in the elderly, it is necessary to comprehensively consider the primary disease or comorbidity of patients and systematically evaluate the overall condition and the local characteristics of wounds of patients. The treatment principles include controlling or slowing down the development of the primary disease, nutritional support, infection control, improving circulation, sealing wounds, and paying attention to the water balance of wounds, at the same time selecting a reasonable treatment plan according to different types of wounds. The goal of treatment is to close the wound as much as possible if conditions permit, while in some cases, palliative management may be appropriate. In the future, the development of smart wear, big data, and artificial intelligence will play a significant role in promoting the assessment and treatment of refractory wounds in the elderly. The Burns and Trauma Branch of Chinese Geriatrics Society organized domestic experts engaged in wound repair and related fields to jointly formulate this consensus, aiming to establish a full-process standard covering prevention, assessment, treatment, and rehabilitation and to promote the standardization and intelligence of diagnosis and treatment of refractory wounds in the elderly, thus providing efficient and homogeneous solutions for clinical practice.

Hormonal interventions in skin wounds - a mini review

The ability to heal from wounds is perhaps the most important biological function that ensures our survival and perpetuation. Cutaneous wound healing typically consists of four characteristic stages, namely hemostasis, inflammation, proliferation, and remodeling, which are carefully carried out by coordinated actions of various cells, cytokines, and hormones. Incoordination of these steps may impede complete and efficient reconstruction and functional recovery of wounds or even lead to worsened outcomes. Hormones, as powerful modulators of organ functions, participate in multiple steps of the wound healing process and play a pivotal role by choreographing the complex interplay of cellular and molecular events. Leveraging the regulatory effects of hormones to enhance the healing process, hormonal therapy has emerged as a promising approach in the clinical treatment of wounds. Current research has focused on determination of the optimal dosages, delivery methods, and combinations of hormonal therapies to maximize their therapeutic benefits while minimizing potential side effects. This review highlights the molecular mechanisms, clinical benefits and side effects of the most commonly used hormones in clinical treatment of wounds.

Targeting estrogen signaling and biosynthesis for aged skin repair

Non-healing skin wounds are disproportionally prevalent in older adults. Current treatments do not account for the particularities of aged skin and result in inadequate outcomes. Overall, healing chronic wounds in the elderly remains a major unmet clinical need. Estrogens play a critical role in reproduction but also have important actions in non-reproductive organs. Estrogen biosynthesis and signaling pathways are locally activated during physiological wound healing, processes that are inhibited in elderly estrogen-deprived skin. Estrogen deprivation has been shown to be a critical mediator of impaired wound healing in both postmenopausal women and aged men, and topical estrogen application reverses age-associated delayed wound healing in both elderly men and women. These data indicate that adequate estrogen biosynthesis and properly regulated estrogen signaling pathways are essential for normal wound healing and can be targeted to optimize tissue repair in the elderly. However, due to fundamental questions regarding how to safely restore estrogen signaling locally in skin wounds, there are currently no therapeutic strategies addressing estrogen deficiency in elderly chronic wounds. This review discusses established and recent literature in this area and proposes the hypothesis that estrogen plays a pleiotropic role in skin aging and that targeting estrogen signaling and biosynthesis could promote skin repair in older adults.

In Silico, In Vitro, and In Vivo Wound Healing Activity of Astragalus microcephalus Willd

Methods

The methanolic root extract was prepared by maceration, and flavonoids were evaluated by LC/MS. In silico examination was performed based on the LC/MS results, and the binding affinity of these compounds to estrogen receptors (ERs) α and β was evaluated. Wound healing evaluation in both in vitro (NHDF cell line, by 500 μg/ml concentration of the extract, 24 h) and in vivo (Wistar rat, topical daily treated with 1.5% of the extract ointment, 21 days) conditions in comparison to control groups was conducted. Rats' control groups included silver sulfadiazine, Vaseline, and the nontreated groups.

Results

Eleven flavonoids were detected using LC/MS. The in silico study showed that formononetin, kaempferol-based structures, quercetin-3-O-neohesperidoside, and calycosin-7-O-beta-D-glucoside had a high affinity (<-6.3) to ERs α and β. Wound closing measurement showed significant improvement in the group treated with the extract in both in vitro and in vivo assays compared to the control groups. Histopathological results confirmed these findings; inflammation factors decreased, and fibroblast proliferation, fibrosis, and epithelization increased, especially in the extract group.

Conclusion

This study shows that Astragalus microcephalus has wound healing activity in vitro and in vivo with low toxicity due to the presence of flavonoids, especially isoflavonoids, which show a high affinity to bind to ERs α and β in the skin tissue.