Vitamin E and THE SKIN, PART II: ANTI-OXIDANT EFFECTS

In the last posting, I laid out the uncertainties of using Vitamin E directly on skin to reduce or prevent scars. In this post, I discuss the antioxidant effects of Vitamin E.

OXIDATIVE STRESS is the issue. Oxidative stress occurs when chemicals called ‘free radicals’ form naturally or following injury (surgery, smoking, sun damage). Free radicals damage DNA, destroy cell membranes, and trigger inflammation. They have been implicated in the development of skin cancer. Vitamin E neutralizes free radicals, thus protecting cells from oxidative stress.

True Vitamin E deficiency occurs only in rare diseases where dietary absorption is poor. However, a study of almost 10,000 individuals suggested that the majority of men and women in the U.S. don’t meet current recommended dietary intake of Vitamin E. In addition, studies have shown that outer layers of skin have a relative shortage of natural antioxidant protection.

THEREFORE, THE QUESTION: Does supplemental Vitamin E (orally or topically on the skin) deliver real health benefits?

THE ANSWER: Possibly.

THE EVIDENCE: Hundreds of well-designed trials have been published in which oral Vitamin E alone or in a cocktail of multiple antioxidants was used as treatment in a wide range of diseases. Some were successful, some failed.

A partial list of successes with oral Vitamin E: Eczema (atopic dermatitis); tinnitus; mucositis after chemo in kids; glaucoma; early macular degeneration; kidney damage after lithotripsy; skin barrier function; post-radiation saliva flow; recurrent embryo loss; cholesterol levels in kidney patients; vitiligo; melasma; kidney damage after contrast exposure; cardiovascular disease; mastalgia; non-alcohol fatty liver.

A partial list of failures: Sjogren’s syndrome; exercise-induced oxidative stress; drug-induced neurological side effects (tardive dyskinesia); sexual dysfunction in men; acute mountain sickness; glaucoma surgical complications; prostate cancer; fatty liver in adolescents; Down’s syndrome; throat cancer; and SKIN CANCER.

Re: failure of Vitamin E in SKIN CANCER: A huge study in France showed that dietary supplementation with a cocktail of oral Vitamin E, C, Zinc, selenium and carotene was associated with an increase in skin cancers in women but not in men. The authors speculated that the sun damage may have occurred long before the antioxidant treatment was started. They also reported prior studies showing increased melanoma risk in women who had supplemented with selenium.

The largest body of evidence with topical Vitamin E supports its use as a photo-protective agent. Many studies demonstrate that Vitamin E protects against the damaging oxidative effects of sunlight (ultraviolet light exposure). Studies have also proved that the addition of topical Vitamin C enhances the antioxidant effect of Vitamin E. Unfortunately, concentrations of Vitamin E in cosmetic products vary widely and an optimal concentration has never been established.

In summary, topical Vitamin E can help protect against sunburn and the long-term aging effects of UV. Whether it protects against skin cancer is not known. A bigger question remains, though: Is Vitamin E more effective than sunscreens and sun avoidance behavior? More studies are needed. At the present time, no dermatologist would recommend Vitamin E-containing products as substitutes for sunscreens.

TAKE-AWAY POINTS:

1. Vitamin E can help in the management of several medical conditions.
2. Most of the known benefits of Vitamin E come from antioxidant properties that prevent or reduce tissue damage from inflammation.
3. Since dietary intake of Vitamin E is often inadequate, daily supplementation in the range of 400 to 800 I.U. may be beneficial and appears to be safe.
4. Topical Vitamin E can help prevent oxidative stress in the skin, and may be helpful in treating vitiligo (pigment loss) and melasma (increased pigment).
5. Vitamin C enhances the antioxidant effect of Vitamin E.
6. Although skin reactions can occur with topical Vitamin E, they are not common.

Disclaimer: Dr. Shaw has no financial conflicts of interest pertaining to the products discussed in this blog post.

NEXT: Sun protection: myths and truths.

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.