Psychological Stress and Wound Healing in Humans

What We Know

Valentina S. Lucas, RN, MS, ANP-BC


Wounds. 2011;22(4):76-83. 

In This Article

Hydrogen Peroxide Foaming Test

Two studies identified for this review utilized the hydrogen peroxide response test to assess wound healing. This method measures the quality of the epithelial barrier. The process involves the application of a small amount of hydrogen peroxide to the wounded area. Catalase, an enzyme found in connective tissue, liberates oxygen gas and water from the hydrogen peroxide. If the epithelial layer is disrupted, then foaming is visible at the wound site as oxygen is liberated. If the epithelial layer is intact, the diffusion of hydrogen peroxide does not take place and therefore little or no foaming is visible.[38–40] Therefore, if there is no foaming present after application, the wound is considered healed.

Marucha et al[40] evaluated the effects of examination stress on dental students' ability to heal a mucosal wound. Each subject served as his or her own control. Two wounds were placed on the hard palate, the first during summer vacation. The second wound was placed on the contralateral side 3 days before the first major examination of the term. Daily photographs and foaming response to hydrogen peroxide were used to measure healing. Students took significantly longer to heal during the examination period (mean 7.82 days) compared to the vacation period (mean 10.91 days) [F(1,10) = 28.47; P < 0.001] Students scored higher on the PSS and had lower whole blood IL-1β levels during examinations. The decrease in IL-1β demonstrates the decrease in immune function and a possible mechanism underlying the relationship of examination stress to wound healing.

Kiecolt-Glaser et al[38] used hydrogen peroxide foam test to evaluate the effects of psychological stress caused by caring for a relative with Alzheimer's disease on wound healing. Healthy female caregivers and controls were studied simultaneously, matched for age and income. Complete wound healing of a 3.5-mm punch biopsy, as indicated by lack of foaming after the application of hydrogen peroxide, took significantly longer in caregivers (mean 48.7 days, SE = 2.9) than controls (mean 39.3 days, SE = 3.0). Wound healing took on average 9 days longer in caregivers than in controls. In addition, caregivers reported significantly more stress on the PSS than did control participants on study entry (20.5, SE = 1.6 versus 13.7, SE = 1.5, P < 0.002). There was no significant change during the study, nor was there an interaction between group and time.


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