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Vitamin E: Topical Scar Treatment?
1 October 2010
Soft Gel Capsule, http://new.nutrafoodingredients.com/products/capsule/soft-gel-capsule
Scars form on the human skin in many ways. Be it from surgical procedures, acne, or various accidents, such as burns or cuts, it is often hard to remove a scar. Scars are formed when the skin repairs wounds from occurrences such as those listed above. It is the body’s natural healing process where a patch or new growth of skin will form to help the scar heal. This process may take a long time depending on how deep the original wound is and how long the skin will take to regrow and age of skin determines how long it will take to heal (http://www.aad.org/public/publications/pamphlets/cosmetic_scar.html).
Furthermore, the type of scar being examined for determining if the use of Vitamin E can be effective is surgical scarring. These are scars formed post-surgery and it is almost inevitable that they will form. According to Dr. Michael L. Brownstein, the first six weeks after surgery is when scar tissue is formed. As this occurs collagen is deposited into the area and this causes the scar to rise. Sometimes surgical, or hypertrophic scars, will flatten, and sometimes this desired effect does not happen and the scar remains elevated. This depends on the skin type, age, and size of the area affected (http://www.brownsteinmd.com/installment1.html).
With this form of scarring it is often difficult to find treatment. Many different types of treatments are on the market and have been proposed such as the use of plastic surgery, ointments and creams like Scar Fade of Mederma, and also laser technology. Brownstein reports that in a recent article in the Journal of Plastic and Reconstructive Surgery, for reducing the amount of scarring, most treatments would only be 25% to 50% effective. Upon learning this fact, it may be discouraging to many trying to reduce the size and appearance of their scars, and yes people may try anything. There have been suggestions that the gel in Vitamin E capsules can be used as a topical treatment of scars due to its antioxidant qualities.
Vitamin E is part of a group of fat soluble compounds that perform antioxidant activities. Antioxidants perform different tasks but are mainly needed in the human body to protect against free radicals. According to Wolf, Wolf, and Ruocco (2006), free radicals are molecules that have one unshared electron and are often essential in many biological systems. Some can be toxic and malignant and others, known as reactive oxygen species (ROS), can cause damage to compounds in the human body. This is where Vitamin E comes into play. This compound, scientifically known as tocopherol, stops the formation of ROS and in turn protects the body from the damaging carcinogens our bodies are exposed to everyday. For this reason, it is no surprise that many scientists and dermatologists are doing research to see if the vitamin’s antioxidant properties can prevent aging, and help reverse other skin ailments such as scars.
According to Nachbar and Korting, “the possible therapeutic use in different cutaneous disorders and pharmacological and toxicological aspects are discussed.” This being said, it is only evident that researchers would look into the idea of vitamin e as a healing agent for the skin. After examining three studies that have explored whether or not Vitamin E is effective as a topical treatment a conclusion will then be made about its effectiveness.
The first study is one conducted by researchers at the University of Miami Department of Dermatology and Cutaneous Surgery. The goal of Baumann and Spencer (1999) was to determine if topically applied Vitamin E has any effect on the cosmetic appearance of scars. The study went as follows: First they gathered a group of 15 people who had undergone skin cancer removal surgery. The researchers provided each with two ointments, A) Aquaphor which is an emollient, or a substance used to soothe and correct dryness and scaling of the skin, and B) Aquaphor mixed with Vitamin E. The participants’ scars were divided into two sections and were told to apply ointment A to part of the scar labeled A and ointment B to part of the scar labeled B. The physicians would then evaluate the progress at weeks 1, 4, and 12 during this 12-week long study.
This was a double-blind study meaning both the researchers and the participants did not know which ointment, A or B, contained the Vitamin E until the very end of the experiment. Results show that although both ointments proved to be excellent at healing the scars, ointment B seemed to work better with the addition of the Vitamin E. As pictured in Figure 1, one can see the division of the scar and the end results after 12 weeks. To further understand how this combination of Aquaphor and Vitamin E worked so well one will need to look into what exactly is Aquaphor. It is a product in which the main ingredient is petrolatum and is common household item used for treating scars. Petroleum is a hydrocarbon is known for its skin-healing abilities because of hydrocarbon’s ability of catenation, or to form covalent bonds, which helps skin heal. (http://en.wikipedia.org/wiki/Petroleum_jelly). The only criteria the researchers used to determine which ointment was effective simply was the degree to which the scar’s appearance improved. For this reason, it was easy for Baumann and Spencer to draw the conclusion that the Aquaphor and Vitamin E mix drew better results. Though this conclusion and the above example may show that Vitamin E could be helpful, the study also showed that many of the participants produced a rash or erythema on side B. This proved to be problematic and many participants at week four dropped out of the study. They drew the conclusion that though it is thought that Vitamin E can help speed up the healing process of scars, it is likely that it only helps with a small percentage of people with post-surgical scarring. In order to draw any conclusions more research is still needed.
The next study was performed by Palmieri, Gozzi, and Palmieri (1995) to, again, test the effectiveness of the use of topical Vitamin E in hypertrophic scars. In this double-blind study, the three scientists took a group of eighty participants ranging in age from 18 to 63 and separated them into two groups. The first 40 participants were put into a group where their scars would be covered with silicone gel plates and an addition of Vitamin E. The second 40 were to have their scars covered with a simple silicone gel sheets. Silicone gel sheets are simply adhesive sheets with gel on one side that is said to help in the healing of hypertrophic scars and keloids. In this 2 month study, the participants’ progress was documented at 4 weeks and again at 8 weeks. Contrary to the findings of the Baumann and Spencer study, the study of Palmieri, Gozzi, and Palmieri yielded much more positive results. They found that those participants with the silicone gel plates with Vitamin E had a greater success rate at their scars healing than those with just the silicone plates. Though this evidence could prove to be sufficient, another study is needed to make an accurate conclusion about Vitamin E.
The third and last study performed by Jenkins et al (1986) at the Shriners Burn Institute in Cincinnati was a randomized study to test whether steroids of topical Vitamin E use was more effective at reducing the appearance of surgical scars. The 111 patients were chosen at random to either receive a base cream known as Aristocort A or a base cream with Vitamin E. The study lasted 120 days and the criterion for how effective the creams are were based on the scar thickness, change in graft size, and overall change in cosmetic appearance. The scientists’ conclusions noted that neither the vitamin E nor steroid cream were very effective at healing and changing the cosmetic appearance of scars. Like the first study of Baumann and Spencer, Jenkins et al, found cases of rashes prevalent in many of the participants.
From earlier research and upon first learning about the functions of Vitamin E and possible healing effects it was convincing that Vitamin E is able to heal most, if not all, surgical-related scarring. However, after delving deeper into the world of journal medicine it is discovered that this information is misleading. Summarizing the three studies, there were many similarities and differences with the findings. Both the first study of Baumann and Spencer and the last study of Jenkins et al found that rashes were often a side effect of the creams. As a result there is a possible correlation between the vitamin E mixtures and the top layer of the skin, that can cause irritation in the skin. However, in the second study of Palmieri, Gozzi, and Palmieri there were no reports of rashes, but at the same time, this study like the first, proved that vitamin E can help change the appearance of scars. To answer the overarching question of whether or not it is truly effective, I feel there is still more research to be done, but at this point the conclusion can be made that, on its own, Vitamin E used topically is not a very effective method of healing scars. According to Zarada, Kriegel, and Davis (2006), their conclusions about Vitamin E coincide with the deduction previously made. According to their review in the Journal of the American Academy of Dermatology, Vitamin E alone is not enough to heal pre-existing hypertrophic scars. However, when used with another form of scar treatment such as Aquaphor or silicone gel sheets, there is evidence that it can improve scar appearances. Therefore, in conclusion, as previously stated, the use of Vitamin E alone to heal scars should be discouraged and those with scars should seek other methods of treatment before trying this commonly-known home-made remedy.
Baumann, L.S., & Spencer, J. (1999). The effects of topical vitamin e on the cosmetic appearance. Dermatologic Surgery, 25(4), 311-315.
Jenkins , M., Alexander, J.W., MacMillan, B.G., Waymack , J.P., & Kopcha , R. (1986). Failure of topical steroids and vitamin e to reduce postoperative scar formation following reconstructive surgery. Journal of Burn Care and Rehabilitation, 7(4), 309.
Nachbar, F., & Korting , H.C. (1994). The role of vitamin e in normal and damaged skin. Journal of Molecular Medicine, 73(1), 7-17.
Palmieri, B., Gozzi, G., & Palmieri, G. (1995). Vitamin e added silicone gel sheets for treatment of hypertrophic scars and keloids. International Journal of Dermatology, 34(7), 506-509.
Vitamin e: health professional fact sheet. (2009, December 15). Retrieved from http://ods.od.nih.gov/factsheets/vitamine.asp
Wolf, Ronnie, Wolf, Danny, Ruocco, Vincenzo (2006). Vitamin E: The Radical Protector. Journal of the European Academy of Dermatology and Venerology, 10 (2), 103-117.
Zurada, J. M., Kriegel , D., & Davis , Ira. (2006). Topical treatments for hypertrophic scars. Journal of the American Academy of Dermatology, 55(6), 1024-1031.
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