VITAMIN E AND THE SKIN: part one

        or

Does Vitamin E prevent or treat SCARS?

                               by James Channing Shaw, MD

Vitamin E is an immensely popular treatment for minor wounds and scars. Belief in this treatment, however, is not entirely based on scientific evidence.

What is the evidence that Vitamin E prevents scars?

The answer: The evidence, so far, is mixed.

Scar, thickened dermis

Normal skin, low-power

Evidence does exist to support the concept of scar treatment with Vitamin E. Scars are made by cells called fibroblasts in the dermis layer of the skin. Vitamin E applied to the skin does penetrate into the dermis where collagen is made and in laboratory settings, Vitamin E can prevent the production of collagen by fibroblasts.

Despite the laboratory evidence, studies of Vitamin E and scars in human patients are small and have shown mixed outcomes.

In a study of 159 scar revisions in burn patients (1986)¹, researchers showed no benefit with Vitamin E cream over plain cream or steroid cream, and almost twenty percent of patients developed rashes from the Vitamin E product.

In a small study (1999) ², fifteen patients applied a plain cream to one half of their healing scar, and a Vitamin E cream to the other half. There was no long-term benefit with the Vitamin E cream, and one third of those using Vitamin E developed skin reactions. The authors discouraged the use of Vitamin E.

A more promising study involved 428 children in Italy (2010) ³  under the age of ten. Half of the children undergoing a small inguinal (hernia) surgery were given a Vitamin E gel to use twice daily for fifteen days before the surgery and thirty days after the surgery. After six months, parents reported ‘keloids’ in 6.5% of the non-Vitamin E group, but no parents reported ‘keloids’ in the treatment group. While this study had design flaws, and no pictures of the keloids (which are highly unusual in children anyway), the authors proposed a possible benefit with Vitamin E.

One study⁴  suggested that it is likely the moisturizing barrier protection of Vitamin E oil and silicon gels that had benefit in wound healing and scar prevention. To add to that theory, two well-designed studies ^{5 ,6}  of wound healing showed that a non-medicated ointment (Aquaphor in this case) was superior to antibiotic ointments after laser surgery, supporting the thinking that moisturizing barrier protection may be more important that the Vitamin E itself.

TAKEAWAY POINTS:

1. Topical Vitamin E has properties that have the potential to be beneficial to the cosmetic appearance of certain scars.
2. Large, well-designed studies are needed to prove it.
3. The risk of using Vitamin E on wounds following minor surgeries is small.
4. Up to one third of patients using topical Vitamin E can develop rashes.
5. It may be the oil base, not the Vitamin E itself, that helps with healing.

Next blogpost: Vitamin E as antioxidant

References:

1. Jenkins M et al. JCBR, July/August 1986
2. Baumann L et al.  Dermatol Surg 1999;25:311–315
3. Zampieri N et al. Journal of Plastic, Reconstructive & Aesthetic Surgery (2010) 63, 1474-1478.
4. Panin G et al. Ann. N.Y. Acad. Sci. 1031: 443–447 (2004).
5. Draelos Z et al. J Am Acad Dermatol 2011, VOL 64, N0 3; S23-S29.
6. Trookman N et al. J Am Acad Dermatol 2011 VOL 64, No 3; S8-S15.