Wound healing, angiotensin-converting enzyme inhibition, and collagen-containing products: a case study.
BACKGROUND
The effects of multiple medications may impair or enhance wound healing. A review of the literature for drug side effects identified cell culture and case studies of angiotensin-converting enzyme inhibitors (ACEIs) impairing collagen deposition in cutaneous wounds; these medications have also been used to prevent or minimize keloid formation.


METHODS
A 71-year-old male patient presented with a venous leg ulcer (VLU), having incurred a crushing injury and fracture requiring surgical repair 16 years earlier. The patient's history was significant for obesity, smoking 1 cigar daily, hypertension, and lower extremity venous insufficiency; medications included amlodipine and lisinopril. The wound initially responded well to advanced wound products and compression, but wound healing subsequently stalled. A collagen-containing alginate dressing was added to the treatment regimen and the wound closed within 2 weeks.


CONCLUSIONS
We postulate that lisinopril may have contributed to the observed delayed healing and targeted this potential impediment to wound healing with a readily available topical collagen-containing product resulting in a rapid wound closure after a significant delay in progress toward wound healing.
Charles P. Buscemi, PhD, ARNP, FNP-BC, CWCN, Assistant Professor, Clinical, Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, and Wound Care Specialist, WoundTech, Hollywood, Florida. CarolAnn Romeo, BSN, RN, CWCN, Doctoral Student, Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami.
Charles P
CP
Buscemi
CarolAnn
C
Romeo
D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D003094:Collagen / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D009779:Occlusive Dressings / Q000706:statistics & numerical data*; D014945:Wound Healing / Q000187:drug effects*
D000806:Angiotensin-Converting Enzyme Inhibitors; D000891:Anti-Infective Agents, Local; D003094:Collagen