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New methods to accelerate wound healing

New methods to accelerate wound healing

Although bandages and antibiotic ointment are staples in my house, doctors have need of more advanced treatments for wound healing beyond these simple first aid tools. By researching how our skin heals, they have incorporated pH adjustment, ions and lasers to help those who suffer from large or slow-to-heal wounds.  These are very non-invasive ways to help get patients back to their normal function more quickly and with less pain.

What’s your pH?

In our article on alkaline water, we discussed pH: what it is and that our bodies regulate the pH of our blood and tissues carefully.  Scientists took information on healthy tissue and compared it to wounds.  According to the 2021 book Digital Health: Exploring Use and Integration of Wearables (chapter 6), healthy skin has a pH value of approximately 5.5 (acidic), but for infected wounds, the pH value is in the range of 7-8.5 (neutral to alkaline).  The alkaline nature of pH in the wound is due to the presence of bacterial colonies and enzymes. When a wound is kept in an acidic condition, the fibroblasts proliferate more actively and the wound healing process is stimulated more while an infected wound shows a slightly alkaline pH environment due to certain enzyme activities, bacterial colonization, and formation of protein structures.  Consequently, several research groups have developed dressings which incorporate pH-sensitive materials.

In addition, this theory of how acidic environments prevent or retard infection holds true for other entry points of infection in the body:

Consequently, those tissues that are closer to neutral pH or alkaline, may be more susceptible to infection:

  • The normal pH for the esophagus is close to 7.0. (Johns Hopkins)
  • The eyes: “The normal physiological pH of ocular surface in humans to be 7.11±1.5. They also showed an increase in ocular surface pH early in the morning and a gradual increase in pH to more alkali levels during the day.” (2014 NIH article)
  • According to Healthline.com, “ A normal blood pH level is 7.35 to 7.45 on a scale of 0 to 14, where 0 is the most acidic and 14 is the most basic. This value can vary slightly in either direction.” 

Hence, it’s very important that microbes are stopped at our body’s first lines of defense!  Acidity is one way of preventing infection and speeding healing, but scientists have discovered that ions can also help.  As you may know, there are two varieties of ions: negative and positive.  They work in different ways to assist healing.  

Negative ions can be applied via negative ion misting machines (using sterilized water), corona devices, or bipolar ionization (like HypoAir units).  They produce negative ions by the hundred-thousand or millions, while normal air only has hundreds or thousands of the ions.  Negative ions were found to have antioxidant and anti-inflammatory effects in this 2021 study.  In this 2022 study, it was inferred that increased wound healing was due to a hydrogen peroxide scavenging effect provided by the ions.  

On the other hand, excess positive ions in the air do not promote healing, but positive ions produced by copper and silver are often used in bandages to do so.  These metals produce positive ions when they are placed in contact with the skin or wound, which enhance angiogenesis (formation of new blood vessels), anti-inflammatory power, as well as being anti-microbial to prevent infection during healing. (2014 study)  To increase contact and ions produced, researchers have designed bandages with nanoparticles of silver and/or copper.  

Lasers are another tool in the box for doctors to help their patients heal.  Traditionally low-power lasers and LEDs have been used in phototherapy of large or otherwise slow-healing wounds.  However, high-power unfocused lasers have also recently been used.  The advantage of lasers for wound healing are that they reduce pain, inflammation and exudates (weeping of fluids from the wounds), as well as reduce scar tissue and help the body to granulate tissue in a more organized way.  Laser sessions last only seconds to minutes and are painless for the patient, and in a matter of weeks they can see new skin being formed to close the wound.

Our bodies can normally heal themselves with simple wound care, but infections and  co-morbid conditions like diabetes or circulation problems can severely impact healing.  That’s when harnessing wound pH management, applying positive or negative ions, or laser therapy can help get the healing going.

Advances in Phototherapy

Advances in Phototherapy

Phototherapy, or light therapy, is the exposure to direct sunlight or artificial light at controlled wavelengths in order to treat a variety of medical disorders. (Light therapy) Light therapy has been around for a long time.  Natural sunlight is free and abundant in many climates, and doctors have known that it does other things for our bodies like assisting in producing vitamin D, elevating mood and killing dangerous bacteria and mold on our skin.  However, natural sunlight is not always available, and also has ultraviolet wavelengths that can be dangerous in longer doses.  New technology is able to select the wavelengths and with the right exposure, provide the same healing benefits as natural sunlight without additional skin cancer risks. 

Phototherapy is now a standard treatment for skin conditions like psoriasis (raised, red, scaly patches on skin), vitiligo (loss of color on patches of skin), eczema (a condition that makes your skin red and itchy), as well as various forms of skin cancer.  The key to healing is selecting the correct wavelength, intensity and duration of exposure, which are determined by research trials on animals and humans.  Ultraviolet light has been classified into three groups of descending wavelengths: UV-A, UV-B and UV-C (for more in-depth explanation on wavelength, visit our article here).  UV-A and -B are the types used for phototherapy, with UV-B being further broken down into narrow-and broad-bands.  Narrow band UV-B has been found to be most effective for psoriasis, for example, and can be produced by traditional ultraviolet lamps, or LED bulbs.  Excimer lasers have been approved by the Food and Drug Administration (FDA) for treating chronic, localized psoriasis plaques by emitting a high-intensity beam of UVB. (Phototherapy)  These treatments can be applied in doctors offices or at home using approved medical equipment and prescription.

Since we know that sunlight has the power to purify water and disinfect surfaces like sheets, fabric and plastics, we know that it is actually killing microbes as well.  Again, it’s the UV wavelengths in sunlight (including UV-C) that break up DNA and inactivate microbes and mold.  Why not apply this to skin and wounds to kill infections?  Ultraviolet light was first used to sterilize bacteria over 100 years ago, a treatment based on the work of Niels Finsen, who won the Nobel Prize in Physiology in 1903 for using filtered sunlight as a cure for skin tuberculosis.  Now uv light is being used in tandem with antibiotics to enhance their effects and overcome antibiotic resistance, which is a growing problem.  Bacteria can evolve to resist drugs, but bacteria cannot resist the destructive power of UV light.  

Antimicrobial photodynamic therapy (aPDT) is a chemical reaction triggered by visible light for use on antibiotic-resistant bacteria strains.  It involves molecular oxygen, light, and a photosensitizer (something that creates a reaction between oxygen and light). To test it, researchers used an already FDA-approved dye called methylene blue as a photosensitizer, and specially constructed panels of 25 LEDs in reflective cones.  Light and photosensitizer were tested with Methicillin-resistant Staphylococcus aureus to determine the lowest dose and shortest series of antibiotics that could weaken the bacterial membranes and other resistance mechanisms.  The resistant bacteria, weakened by aPDT treatments, were killed with far lower doses of current antibiotics, and it’s a promising method for treating resistant bacteria in wounds and reducing antibiotic use in general.  (Light-Based Therapy Weakens Antibiotic-Resistant Bacteria)

At the other end of the light spectrum (literally), red and infrared lights also promote wound healing, but possibly for different reasons.  Although a Danish physician (Niels Ryberg Finsen) received a Nobel Prize in 1903 for discovering that exposure to concentrated red light accelerated the healing of sores, scientists today are only beginning to learn how and why this happens.  Research funded by NASA in the 1990’s showed that near-infrared laser light speeds healing of wounds, particularly those that are starved for oxygen, by boosting the production of growth-factor proteins, collagen, and blood vessels.One company that spun out of NASA’s programs is Multi Radiance Medical, which produces laser units for physicians, athletic trainers, physical therapists,  chiropractors, and veterinarians.   Although lasers have the possibility of damaging surrounding tissue, and they also use a lot of energy and they’re expensive, LED arrays are a better alternative.  They are cheaper, use less energy, can be designed to emit multiple wavelengths, and cover a larger area than a laser.  (NASA Research Illuminates Medical Uses of Light)  This is where the consumer must be careful, however, as today there are many manufacturers of LED red light therapy devices, and without applying the research of specific wavelengths, intensity and timed sessions, these devices are simply lamps, not healing devices.  When searching for a red light therapy device, you want to look for a device with 600 to 900 nanometers (nm) of light, as well as one that is easy to use or easy to wear. (Red Light Therapy Review)  Therefore, it’s wise to research the manufacturer on their knowledge of the technology, dosage instructions and independent testing of their products for wavelength, flicker rate.  This manufacturer has developed a helpful blog to understand red light therapy and its uses.

Here’s the best part: despite all the technology and expense, the benefits of UV light and infrared light can be free.  We know that sunlight has the “full spectrum” of light–from ultraviolet to infrared–and it can be helpful in moderate doses, not "lying on tinfoil basking like a trout"!  With the right intensity and dosage, it doesn’t have to hurt your skin, but can actually heal it.  Our parents and grandparents might have advised us to “get out in the sun”, and moderate exposure is the key to getting more benefits than downsides.  

Photo by Kent Pilcher on Unsplash