PracticalDermatology

Regenerative medicine is helping to revolutionize wound care in dermatology. Robert S. Kirsner, MD, PhD, Chairman and Harvey Blank Professor of the Department of Dermatology and Cutaneous Surgery and a Professor in the Department of Public Health Sciences and Director of the University of Miami Hospital and Clinics Wound Center at the University of Miami Miller School of Medicine, explains how and why this matters. “Advances in basic understanding of healing can unravel the mysteries of skin biology and normal and disease pathophysiology including aging,” he says. “Undoubtedly discoveries of today will [help us] deliver better therapies tomorrow.“

What’s the latest in wound healing?

Robert S. Kirsner, MD, PhD: New developments in wound healing include novel skin grafting tools, repurposing of existing medications, development of biomarkers to predict healing and response to therapy, and new approaches to treat bacteria, among others. New grafting techniques have recently focused on limiting donor site morbidity while retaining clinical efficacy.

Beta blockers, statins, and chelating agents are being refitted to help heal wounds that are not healing and to heal patients faster and better.

Tissue, blood, and imaging biomarkers are being developed to help distinguish those wounds that are progressing from those that are not healing and predict the efficacy of new and existing therapies. New understanding of bacteria in terms of how they exist (ie., planktonic v. biofilm) and how they are measured (ie., microbiome) has lent insight to potential new treatments of bacteria that can improve healing.

Do dermatologists pay enough attention to the field?

Dr. Kirsner: Many skin diseases present as wounds or result in wounds. Additionally, dermatologists create the most wounds of any medical specialty, through biopsies and after surgical and aesthetic procedures. Optimizing care of wounds created by disease and optimizing care of wounds created by diagnostic or therapeutic procedures would improve overall quality of care. Not only is time to healing important, but ease of treatment and quality of healing is critical as well. Therefore it would be natural for dermatology and dermatologists to embrace the position as leading wound care providers, but we do not. Unfortunately, wound care is often not taught (or taught extensively) in training, and as a result dermatologists often do not embrace wound care.

Why is wound healing so vital from a patient perspective?

Dr. Kirsner: Patients often care more about the surgical scar created by a surgery than the reason the surgery was performed. Improved wound care can improve patient outcomes, speed resolution of disease and promote faster healing, reduce pain, and improve scarring.

Have there been any breakthroughs in terms of using regenerative medicine for wound healing?

Dr. Kirsner: We are learning a lot about regenerative medicine and healing. Understanding the mechanisms of scarring and which cells participate and how these cells are engaged is leading to new therapeutic approaches.

We are also learning more about how stem cells work. Stem cells work through the extracellular vesicles they secrete and this has opened opportunities to capitalize on regenerative capabilities of stem cells without the need of delivering the cells themselves.