[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Tissue repair](https://durgical.com/en/general-pathology/#a-repair) › What delays healing: infection, diabetes, nutrition, glucocorticoids, poor blood flow

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# What delays healing: infection, diabetes, nutrition, glucocorticoids, poor blood flow

- Topic

Wounds heal slowly when they are infected, poorly perfused or under pressure, or when the person has diabetes, is malnourished or takes steroids.

Updated 2026-11-01

## Key points

- Infection is the most important local cause of delayed healing.
- Diabetes: vascular disease + neuropathy + poor leukocyte function.
- Collagen needs protein, vitamin C (hydroxylation), copper (cross-linking) and zinc (metalloproteinases, proliferation).
- Glucocorticoids weaken scars by suppressing inflammation and TGF-β.
- Pressure, ischaemia and venous hypertension produce chronic ulcers.

## What it is

Healing needs oxygen, nutrients, a clean wound bed and well-regulated inflammation. Anything that lowers blood flow, prolongs inflammation, weakens collagen synthesis or blunts the immune response slows it down. Infection is the single most important local cause; diabetes, malnutrition and glucocorticoids are the classic systemic ones. Most chronic wounds have more than one factor at work.

## Key facts

- Systemic factors: diabetes, malnutrition, vitamin and trace element deficiencies, glucocorticoids, age, smoking, cancer, kidney failure.
- Local factors: infection, poor blood flow, pressure, mechanical stress, foreign bodies, necrotic tissue, wound size and location.
- The same anti-fibrotic effect of glucocorticoids is used on purpose: steroid injections are a treatment for keloids.

## Factors that delay healing

| Factor | How it delays healing |
| --- | --- |
| Infection | Prolongs inflammation and increases tissue damage; the most important local cause |
| [Diabetes mellitus](https://durgical.com/en/conditions/type-2-diabetes-mellitus/) | Small- and large-vessel disease, neuropathy (unnoticed trauma), poor neutrophil function, glycation of collagen |
| Poor perfusion | Atherosclerosis (arterial ulcers) or venous hypertension (venous ulcers) limit oxygen and nutrient delivery |
| [Pressure and movement](https://durgical.com/en/conditions/pressure-injury/) | Pressure blocks capillary flow (pressure injury); movement and tension tear new tissue |
| Foreign bodies and necrotic tissue | Keep inflammation going and shelter bacteria |
| Protein-energy malnutrition | Less collagen and matrix synthesis; weaker immunity |
| [Vitamin C deficiency (scurvy)](https://durgical.com/en/conditions/scurvy/) | Defective hydroxylation of proline and lysine: unstable, weak collagen |
| [Zinc and copper deficiency](https://durgical.com/en/conditions/zinc-deficiency/) | Zinc: cofactor of metalloproteinases and cell proliferation; copper: lysyl oxidase cross-linking |
| Glucocorticoids | Suppress inflammation and TGF-β, reduce collagen synthesis: weak scars |
| Other | Older age, smoking (vasoconstriction, hypoxia), radiation, chemotherapy, obesity, uraemia, cancer |

## Clinical notes

- The diabetic foot ulcer combines neuropathy, ischaemia and infection; it is a leading cause of non-traumatic amputation.
- Pressure injuries form over bony prominences (sacrum, heels, hips) in people who cannot move; repositioning and nutrition are central to prevention.
- Venous ulcers sit above the medial malleolus and are shallow; arterial ulcers are on the toes and pressure points, painful and punched out.

## Memory aid

A wound asks for blood, food, rest and cleanliness: ischaemia, malnutrition, pressure and infection take them away, while steroids and diabetes slow the builders.

## Test yourself

Think of the answer, then tap the question to see it.

## Why does vitamin C deficiency impair healing?

Vitamin C is the cofactor of prolyl and lysyl hydroxylases; without it collagen chains cannot form stable triple helices, so scars are weak.

## How does diabetes delay healing?

Vascular disease reduces perfusion, neuropathy allows unnoticed injury and pressure, and hyperglycaemia impairs neutrophil function and favours infection.

## How do glucocorticoids affect a healing incision?

They suppress inflammation and TGF-β, reducing collagen synthesis and fibrosis, so the scar is weaker and dehiscence more likely.

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## Related

- [Healing of skin wounds: first and second intention](https://durgical.com/en/general-pathology/healing-of-skin-wounds-first-and-second-intention/)
- [Granulation tissue and scar formation](https://durgical.com/en/general-pathology/granulation-tissue-and-scar-formation/)
- [Abnormal repair: chronic wounds, hypertrophic scar, keloid, contracture](https://durgical.com/en/general-pathology/abnormal-repair-chronic-wounds-hypertrophic-scar-keloid-contracture/)
- [Severe acute malnutrition: marasmus and kwashiorkor](https://durgical.com/en/general-pathology/severe-acute-malnutrition-marasmus-and-kwashiorkor/)
- [Vitamin deficiencies: what each one does to tissue](https://durgical.com/en/general-pathology/vitamin-deficiencies-what-each-one-does-to-tissue/)
- [Ionizing radiation injury](https://durgical.com/en/general-pathology/ionizing-radiation-injury/)

## Related conditions

- [Diabetic foot](https://durgical.com/en/conditions/diabetic-foot/)
- [Scurvy (vitamin C deficiency)](https://durgical.com/en/conditions/scurvy/)
- [Type 2 diabetes mellitus](https://durgical.com/en/conditions/type-2-diabetes-mellitus/)
- [Type 1 diabetes mellitus](https://durgical.com/en/conditions/type-1-diabetes-mellitus/)
- [Venous leg ulcer](https://durgical.com/en/conditions/venous-leg-ulcer/)
- [Pressure injury (pressure ulcer)](https://durgical.com/en/conditions/pressure-injury/)
- [Peripheral artery disease](https://durgical.com/en/conditions/peripheral-artery-disease/)
- [Kwashiorkor](https://durgical.com/en/conditions/kwashiorkor/)
- [Zinc deficiency (acrodermatitis enteropathica)](https://durgical.com/en/conditions/zinc-deficiency/)
- [Wound dehiscence and evisceration](https://durgical.com/en/conditions/wound-dehiscence-and-evisceration/)
- [Malnutrition and unintentional weight loss in older adults](https://durgical.com/en/conditions/malnutrition-and-unintentional-weight-loss-in-older-adults/)
- [Obesity](https://durgical.com/en/conditions/obesity/)

## Elsewhere in DurgiPedia

- [Vitamin C (ascorbic acid)](https://durgical.com/en/biochemistry/molecules/vitamin-c/)
- [Zinc](https://durgical.com/en/biochemistry/topics/zinc/)
- [Collagen synthesis](https://durgical.com/en/biochemistry/topics/collagen-synthesis/)
- [Actions of cortisol](https://durgical.com/en/physiology/actions-of-cortisol/)
- [Oxygen content, delivery and extraction](https://durgical.com/en/physiology/oxygen-content-delivery-and-extraction/)

## In Pharmacology

- [Corticosteroids (glucocorticoids)](https://durgical.com/en/pharmacology/classes/corticosteroids/)

[← All of general pathology](https://durgical.com/en/general-pathology/)

Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: [Scurvy: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000355.htm) (MedlinePlus, US National Library of Medicine, 2026); [Venous Leg Ulcer](https://www.ncbi.nlm.nih.gov/books/NBK567802/) (StatPearls (NCBI Bookshelf), 2024); [Pressure Sores | Bedsores | Pressure Ulcers | MedlinePlus](https://medlineplus.gov/pressuresores.html) (MedlinePlus, US National Library of Medicine, 2026); [4.6 Tissue Injury and Aging](https://openstax.org/books/anatomy-and-physiology-2e/pages/4-6-tissue-injury-and-aging) (OpenStax (Anatomy and Physiology 2e), 2022).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/general-pathology/what-delays-healing-infection-diabetes-nutrition-glucocorticoids-poor-blood-flow/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/what-delays-healing-infection-diabetes-nutrition-glucocorticoids-poor-blood-flow/