Deciphering skin architecture, wound pathophysiology and molecular mechanisms of healing: insights into immune response and therapeutic strategies

Evidence from laboratory and animal studies provides groundwork for understanding mechanisms and potential before human studies continue.

• Level A · Stronger Clinical Evidence
• Level B · Emerging clinical evidence with positive signals
• Level C · Early human research exploring benefits
• Level D · Scientific groundwork from lab and animal studies
• Emerging · Emerging topic under active research

Abstract (original English)

Skin not only serves as a protective barrier, but also as a dynamic immunological and sensory organ responsible for complex physiological processes. Disruption through trauma, surgery, burns or chronic metabolic disease initiates a tightly regulated healing cascade involving inflammatory signaling, extracellular matrix remodeling, angiogenesis and coordinated cellular responses. While acute wounds generally progress through orderly phases of repair, chronic wounds such as diabetic foot ulcers, venous ulcers and pressure injuries become arrested in persistent inflammatory states characterized by protease imbalance, senescent cell accumulation, impaired vascularization and colonization of microbial biofilms, contributing to significant global morbidity and healthcare burden. This review integrates structural biology, immune mechanisms and molecular signaling pathways that govern wound repair, clearly delineating the differences between acute and chronic healing. Particular emphasis is placed on inflammation-driven dysregulation, extracellular matrix dynamics and defective angiogenesis that underpin chronic wound pathology. Rare and often underrepresented wound types, including radiation-induced and autoimmune-associated lesions, are also discussed to provide a broader and clinically relevant perspective. Importantly, the review highlights translational and technological advances

Evidence level

Evidence from laboratory and animal studies provides groundwork for understanding mechanisms and potential before human studies continue.

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