Stress and wound healing.

There are substantial data to suggest that stress-induced disruption of neuroendocrine immune equilibrium is detrimental to health, with the strongest evidence to date in wound healing. Murine and human studies demonstrated that the down-regulation of the early inflammatory response by an increase in cortisol levels results in delayed wound repair and identified several potential cellular mechanisms linking stress and wound healing. The impact of stress on wound healing has been studied almost exclusively in acute experimentally induced wounds. Because chronic wounds are different entities from acute wounds, the cellular/molecular mechanisms by which stress affects acute wound healing may not necessarily be applied to chronic wounds, hence, the need for studies in stress and chronic wound (eg, diabetic foot ulcer) healing.