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Journal List > Can Fam Physician > v.52(7); Jul 10, 2006

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Can Fam Physician. 2006 July 10; 52(7): 855–856.

PMCID: PMC1781083

Copyright © 2006, Can Fam PhysicianVitamin E for treating children’s
scarsDoes it help reduce scarring?Dipen Khoosal and Ran D. Goldman, MD

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Abstract

Résumé

Vitamin E

Conclusion

References

AbstractQUESTIONA few of my patients have been told to use vitamin E
cream after surgery or repair of a laceration. What is the evidence
for this suggestion, and is this treatment suitable for all patients?ANSWERVitamin
E is the main lipid-soluble antioxidant in the skin. Several anecdotal
reports have suggested that topical use of vitamin E cream can reduce
scar formation. Current evidence from the literature, however, does
not support that proposition. In fact, studies report some adverse
effects with use of vitamin E. Further research is needed before
application of vitamin E cream becomes the standard of care.

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Abstract

Résumé

Vitamin E

Conclusion

References

RésuméQUESTIONCertains de mes patients se sont fait conseiller
d’utiliser de la crème à la vitamine E après une chirurgie ou la
réparation d’une lacération. Quelles sont les données scientifiques à
l’appui de cette suggestion et ce traitement convient-il à tous les
patients?RÉPONSELa vitamine E est le principal antioxydant liposoluble
dans la peau. Quelques rapports isolés ont laissé entendre que l’usage
topique de crème à la vitamine E peut réduire la formation de
cicatrices. Par contre, les données scientifiques dans les ouvrages
récents ne confirment pas cette affirmation. De fait, des études font
état de certains effets indésirables causés par l’usage de la vitamine
E. D’autres recherches sont nécessaires avant que l’application de
crème à la vitamine E devienne la norme de soin.

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Abstract

Résumé

Vitamin E

Conclusion

References

Researchers estimate that close to 100 million patients in the
developing world acquire scars each year.1 The scars arise mostly from
surgical procedures and trauma. A large proportion of these patients,
approximately 4 million of them, acquire scars due to burns. About 70%
of burn victims are children.1 The aftereffects of scars, especially
in children and adolescents, are profound and are mostly attributed to
changes in the appearance of their bodies and disfiguration.2
Consequences of the aftereffects of scars in adults include depression
(13% to 23%); posttraumatic stress syndrome (13% to 45%)2; and
anxiety, diminished self-esteem,3 and overall decreased quality of
life. Thus, there is much interest in the causes of scar formation and
in ways to reduce or remove scars that have already formed.Scarring is
the outcome of the natural healing processes of the body in response
to tissue injury, in particular trauma. A cut due to an accident or
surgery initiates a physiologic cascade of events that lead to tissue
resolution and reconstruction. The first step in this cascade of
events is inflammation: the immune system invades the site of injury
to remove foreign material and harmful agents and destroy invading
organisms. Some of the products released by this process might account
for scar formation.4 Some confirmation of this theory comes from the
discovery that fewer neutrophils are recruited to the site of injury
in fetuses whose wounds heal without scars than are recruited to the
site of injury in adults who acquire scars.4 As the immune system
develops and inflammatory reactions amplify, scars appear more
frequently, indicating the importance of inflammation in scar
formation.4

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Abstract

Résumé

Vitamin E

Conclusion

References

Vitamin EVitamin E was discovered in 1922 by researchers at the
University of California who suggested it had beneficial properties
for skin, especially in support of wound healing and scar repair.5 It
is the main lipid-soluble antioxidant in the skin.6 Vitamin E can be
applied topically and will have good penetration into deep dermal
tissue. Its antioxidative property helps stabilize cell membranes,
including cells of the inflammatory process, and thus reduces the
amounts of chemicals released by those cells.5 Vitamin E is also
believed to have a protective effect against buildup of arterial
plaque and against cancer.7Since the discovery that vitamin E is the
main lipid-soluble antioxidant in the skin, researchers have suggested
that it might have a role in the treatment of skin lesions and scar
formation.6,8 Musalmah et al9 found an accelerated rate of wound
closure in normal and diabetic rats treated with alpha-tocopherol, a
subfamily of vitamin E, possibly due to its antioxidant role. Based on
current evidence, however, it is hard to recommend vitamin E and hope
for promising results.When vitamin E was added to silicon gel sheets
used to treat 80 patients 18 to 63 years old with hypertrophic scars,
the combined action of these 2 chemicals brought success.10 In this
blinded study, patients were randomized to 2 groups, 1 receiving
vitamin E added to silicon gel sheets and the other receiving only
silicon gel sheets. After 2 months, 95% of the study group patients’
scars had improved by 50%; only 75% of the control group patients’
scars had improved by 50% (P < .05).10 In contrast, another study
reported that a randomized group of 159 patients who underwent surgery
for postburn contractures was treated for 4 months with topical
vitamin E,11 which seemed to have no appreciable effect. Patients were
monitored for a year, and observations of scar thickness, change in
graft size, range of motion, and ultimate cosmetic appearance were
recorded. No beneficial effect of vitamin E could be demonstrated. In
a double-blind randomized controlled trial, a topically applied
combination of an emollient and vitamin E did not result in a better
cosmetic effect in postsurgical 2-layer skin closure than when only
the emollient was used.6 Moreover, almost a third of the patients
reported local reactions to the vitamin E cream. These reactions were
mostly contact dermatitis and supported earlier findings of contact
urticaria, eczematous dermatitis, and reactions similar to erythema
multiforme.11,12 The authors suggested that, in some cases, topical
vitamin E even worsened the cosmetic appearance of scars and concluded
that use of topical vitamin E for treating surgical wounds should be
discouraged. A follow-up comment on the study pointed out that d-alpha-tocopherol
is an extremely unstable compound and that breakdown products and
contaminants could account for the inflammatory response observed.13

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Abstract

Résumé

Vitamin E

Conclusion

References

ConclusionAlthough there are anecdotal reports suggesting that topical
application of vitamin E could help remove scars and aid in the
healing process, current evidence does not fully support that
suggestion. In fact, adverse effects should be considered. There is a
clear need for better controlled trials to identify more accurately
the role of vitamin E in wound healing and scar formation, especially
in children.References

Pediatric Pearls is produced by the Pediatric Research in Emergency
Therapeutics (PRETx) program at the Hospital for Sick Children in
Toronto, Ont. Mr Khoosal is a member and Dr Goldman is Director of the
PRETx program. The mission of the PRETx program is to promote child
health through evidence-based research in therapeutics in pediatric
emergency medicine.

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Abstract

Résumé

Vitamin E

Conclusion

References

References1. Bayat A, McGrouther DA, Ferguson MW. Skin scarring. BMJ.
2003;326:88–92. PubMed2. Van Loey NE, Van Son MJ. Psychopathology
and psychological problems in patients with burn scars: epidemiology
and management. Am J Clin Dermatol. 2003;4(4):245–272. PubMed3.
Robert R, Meyer W, Bishop S, Rosenberg L, Murphy L, Blakeney P.
Disfiguring burn scars and adolescent self-esteem. Burns. 1999;25(7):581–585.
PubMed4. Yang GP, Lim IJ, Phan TT, Lorenz HP, Longaker MT. From
scarless fetal wounds to keloids: molecular studies in wound healing.
Wound Repair Regen. 2003;11(6):411–418. PubMed5. MacKay D, Miller
AL. Nutritional support for wound healing. Altern Med Rev. 2003;8(4):359–377.
PubMed6. Baumann LS, Spencer J. The effects of topical vitamin E on
the cosmetic appearance of scars. Dermatol Surg. 1999;25(4):311–315. PubMed7.
Pryor WA. Vitamin E and heart disease: basic science to clinical
intervention trials. Free Radic Biol Med. 2000;28(1):141–164. PubMed8.
Chang CW, Ries WR. Nonoperative techniques for scar management and
revision. Facial Plast Surg. 2001;17(4):283–288. PubMed9. Musalmah
M, Fairuz AH, Gapor MT, Ngah WZ. Effect of vitamin E on plasma
malondialdehyde, antioxidant enzyme levels and the rates of wound
closures during wound healing in normal and diabetic rats. Asia Pac J
Clin Nutr. 2002;11(Suppl 7):448–451.10. Palmieri B, Gozzi G, Palmieri
G. Vitamin E added silicon gel sheets for treatment of hypertrophic
scars and keloids. Int J Dermatol. 1995;34(7):506–509. PubMed11.
Jenkins M, Alexander JW, MacMillan BG, Waymack JP, Kopcha R. Failure
of topical steroids and vitamin E to reduce postoperative scar
formation following reconstructive surgery. J Burn Care Rehabil. 1986;7(4):309–312.
PubMed12. Hunter D, Frumkin A. Adverse reactions to vitamin E and
aloe vera preparations after dermabrasion and chemical peel. Cutis.
1991;47:193–196. PubMed13. Pinnell SR. Regarding d-alpha-tocopherol.
Dermatol Surg. 1999;25(10):827. PubMed

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Articles from Canadian Family Physician are provided here courtesy of
College of Family Physicians of Canada

PubMed articles by these authors
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Khoosal, D.

Goldman, R.

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Compound

PubMed

Substance

ReviewSkin scarring.

BMJ. 2003 Jan 11; 326(7380):88-92.

BMJ. 2003

ReviewPsychopathology and psychological problems in patients with
 burn scars: epidemiology and management.

Am J Clin Dermatol. 2003; 4(4):245-72.

Am J Clin Dermatol. 2003

Disfiguring burn scars and adolescent self-esteem.

Burns. 1999 Nov; 25(7):581-5.

Burns. 1999

See more articles cited in this paragraph

ReviewFrom scarless fetal wounds to keloids: molecular studies in
 wound healing.

Wound Repair Regen. 2003 Nov-Dec; 11(6):411-8.

Wound Repair Regen. 2003

See more articles cited in this paragraph

ReviewNutritional support for wound healing.

Altern Med Rev. 2003 Nov; 8(4):359-77.

Altern Med Rev. 2003

The effects of topical vitamin E on the cosmetic appearance of
 scars.

Dermatol Surg. 1999 Apr; 25(4):311-5.

Dermatol Surg. 1999

ReviewVitamin E and heart disease: basic science to clinical
 intervention trials.

Free Radic Biol Med. 2000 Jan 1; 28(1):141-64.

Free Radic Biol Med. 2000

See more articles cited in this paragraph

The effects of topical vitamin E on the cosmetic appearance of
 scars.

Dermatol Surg. 1999 Apr; 25(4):311-5.

Dermatol Surg. 1999

ReviewNonoperative techniques for scar management and revision.

Facial Plast Surg. 2001 Nov; 17(4):283-8.

Facial Plast Surg. 2001

See more articles cited in this paragraph

Vitamin E added silicone gel sheets for treatment of hypertrophic
 scars and keloids.

Int J Dermatol. 1995 Jul; 34(7):506-9.

Int J Dermatol. 1995

Failure of topical steroids and vitamin E to reduce postoperative
 scar formation following reconstructive surgery.

J Burn Care Rehabil. 1986 Jul-Aug; 7(4):309-12.

J Burn Care Rehabil. 1986

The effects of topical vitamin E on the cosmetic appearance of
 scars.

Dermatol Surg. 1999 Apr; 25(4):311-5.

Dermatol Surg. 1999

Adverse reactions to vitamin E and aloe vera preparations after
 dermabrasion and chemical peel.

Cutis. 1991 Mar; 47(3):193-6.

Cutis. 1991

Regarding d-alpha-tocopherol.

Dermatol Surg. 1999 Oct; 25(10):827.

Dermatol Surg. 1999

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