Azadirachta indica (Neem) in Wound Healing: A Review of Bioactive Compounds, Mechanisms, and Current Translational Evidence

Chronic wounds are significantly increasing the risk of morbidity and amputation in diabetic patients and older people worldwide. Moreover, the widespread use of antibiotics has led to an increase in drug-resistant infections, complicating the healing process, prolonging hospitalization, and increasing the financial burden on healthcare systems. Consequently, plant-derived therapeutics have attracted considerable interest as accessible, biocompatible adjuncts in regenerative medicine. The neem plant (Azadirachta indica) is traditionally known as the “village pharmacy” due to its extensive pharmacological effects, such as antimicrobial, anti-inflammatory, antioxidant, and regenerative activities. This review covers the properties of different neem parts and extracts, their applications, and the molecular mechanisms of its essential bioactive compounds. In addition, it summarizes recent in vitro, in vivo, and emerging clinical findings across different wound types. Furthermore, it critically appraises key translational bottlenecks, including a primary technical barrier related to the lack of phytochemical standardization, non-linear dose responses, and the paucity of well-controlled human trials. Overall, while heterogeneous preclinical evidence supports the biological plausibility and wound-healing activity of A. indica, definitive clinical utility remains unproven across diverse patient cohorts. Future prospective methodology incorporating systematic chemical profiling and adequately powered randomized controlled trials will be essential to establish its clinical utility and safety profile in contemporary wound management.