scar tissue and vitamin E

[Tall_James]

Dr. Steve,

I recently had open gall bladder surgery and now have a large and lovely scar across my stomach. (They weren't able to do it laproscopically). I have heard that some people put Vitamin E on scars to help them fade but want to know what you think about that.

Thanks.

Tall James

[Dr Steve]

Dr. Steve,

I recently had open gall bladder surgery and now have a large and lovely scar across my stomach. (They weren't able to do it laproscopically). I have heard that some people put Vitamin E on scars to help them fade but want to know what you think about that.

Thanks.

Tall James

TJ:

The common wisdom is that E helps. However, studies have not supported this thesis, and I've included one from the medical literature below for your review. In this study, 10% of people had some improvement in the appearance of their scar, 90% had no effect or even some worsening of the scar. The main thrust in the future will be in preventing large scar formation; once they've formed, it's really hard to get rid of the darned things.




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

Comment in:
Dermatol Surg. 1999 Aug;25(8):670-1. Dermatol Surg. 1999 Oct;25(10):827.

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

Baumann LS, Spencer J.

University of Miami Department of Dermatology and Cutaneous Surgery, Miami,
Florida, USA.

BACKGROUND: Vitamin E is a generic term for a group of tocol and tocotrienol
derivatives. Since the discovery that vitamin E is the major lipid soluble
antioxidant in skin, this substance has been tried for the treatment of almost
every type of skin lesion imaginable. Anecdotal reports claim that vitamin E
speeds wound healing and improves the cosmetic outcome of burns and other wounds.
Many lay people use vitamin E on a regular basis to improve the outcome of scars
and several physicians recommend topical vitamin E after skin surgery or
resurfacing. OBJECTIVE: We attempted to determine whether topically applied
vitamin E has any effect on the cosmetic appearance of scars as suggested by
multiple anectodal reports. METHODS: Fifteen patients who had undergone skin
cancer removal surgery were enrolled in the study. All wounds were primarily
closed in 2 layers. After the surgery, the patients were given two ointments each
labeled A or B. A was Aquaphor, a regular emollient, and the B was Aquaphor mixed
with vitamin E. The scars were randomly divided into parts A and B. Patients were
asked to put the A ointment on part A and the B ointment on part B twice daily
for 4 weeks. The study was double blinded. The physicians and the patients
independently evaluated the scars for cosmetic appearance on Weeks 1, 4, and 12.
The criteria was simply to recognize which side of the scar looked better if
there was any difference. The patients' and the physicians' opinions were
recorded. A third blinded investigator was shown photographs of the outcomes and
their opinion was also noted. RESULTS: The results of this study show that
topically applied vitamin E does not help in improving the cosmetic appearance of
scars and leads to a high incidence of contact dermatitis. CONCLUSIONS: This
study shows that there is no benefit to the cosmetic outcome of scars by applying
vitamin E after skin surgery and that the application of topical vitamin E may
actually be detrimental to the cosmetic appearance of a scar. In 90% of the cases
in this study, topical vitamin E either had no effect on, or actually worsened,
the cosmetic appearance of scars. Of the patients studied, 33% developed a
contact dermatitis to the vitamin E. Therefore we conclude that use of topical
vitamin E on surgical wounds should be discouraged.

[Alice S. Fuzzybutt]

Dr. Steve,

I've seen commercials for a product called Mederma. It's supposed to fade scars. Do you know what is in it and would it work on Jim?

[Dr Steve]

Dr. Steve,

I've seen commercials for a product called Mederma. It's supposed to fade scars. Do you know what is in it and would it work on Jim?


Ok, the thing that really cheeses me off about "Mederma" is that NOWHERE on their website can I find the active ingredient. I finally found a study in the literature studying this stuff for keloids (hypertrophic scars...think Seal's face)...but in rabbits, where it showed no efficacy (positive medical effect). This led me to the active ingredient (allium cepa) which, to the best of my detective ability is ONION EXTRACT.

A couple of studies show that onion extract does indeed improve the appearance of surgical scars, but the main study I reviewed was not "blinded" (i.e., the investigators knew who used the gel and who didn't and therefore were biased).

A major study that WAS blinded was Dermatol Surg. 2006 Feb;32(2):193-7. and the conclusion was: "In this side-by-side, randomized, double-blinded, split-scar study, the
onion extract gel did not improve scar cosmesis or symptomatology when compared
with a petrolatum-based ointment."

So I think this stuff won't do any harm, but it may not do any good, either. Lots of doctors use it, but that doesn't mean it actually does anything. The need for rigorous evidence is less in preparations that obviously do no harm.

I got excited when I read the first studies, until I realized that they were crappy in structure. If I find anything interesting on any of this, I'll post. If you all find anything interesting, let me know and I'll research it!

[~Katja~]

Ok, the thing that really cheeses me off about "Mederma" is that NOWHERE on their website can I find the active ingredient. I finally found a study in the literature studying this stuff for keloids (hypertrophic scars...think Seal's face)...but in rabbits, where it showed no efficacy (positive medical effect). This led me to the active ingredient (allium cepa) which, to the best of my detective ability is ONION EXTRACT.

A couple of studies show that onion extract does indeed improve the appearance of surgical scars, but the main study I reviewed was not "blinded" (i.e., the investigators knew who used the gel and who didn't and therefore were biased).

A major study that WAS blinded was Dermatol Surg. 2006 Feb;32(2):193-7. and the conclusion was: "In this side-by-side, randomized, double-blinded, split-scar study, the
onion extract gel did not improve scar cosmesis or symptomatology when compared
with a petrolatum-based ointment."

So I think this stuff won't do any harm, but it may not do any good, either. Lots of doctors use it, but that doesn't mean it actually does anything. The need for rigorous evidence is less in preparations that obviously do no harm.

I got excited when I read the first studies, until I realized that they were crappy in structure. If I find anything interesting on any of this, I'll post. If you all find anything interesting, let me know and I'll research it!


I am pretty surprised that they get away without labeling their active ingredients on the website. The FDA has so many regulations when it comes to labeling, even for cosmetics, which I would consider this a cosmetic treatment rather than medical.

[Tall_James]

Thanks Dr. Steve (& Alice). Looks like this scar is here to stay then. I think I'm going to have to now fall back on my career as a pirate.

Argggh!

[Freakshow]

Just remember chicks dig scars. Pain is temporary. Glory lasts forever. et cetera, et cetera, etc...

[Jughead]

Just remember chicks dig scars. Pain is temporary. Glory lasts forever. et cetera, et cetera, etc...

Thank God....:thumbup:

[DolaMight]

"Scar Tissue and Vitamin E" would make make a good morning zoo name.

[Alice S. Fuzzybutt]

"Scar Tissue and Vitamin E" would make make a good morning zoo name.

I like "Dingo and The Baby."

http://thumbnails.hulu.com/9/105/28400_145x80_generated__mRemCNfgLEWtd5Px5yN3gw.jpg

[Thebazile78]

I am pretty surprised that they get away without labeling their active ingredients on the website. The FDA has so many regulations when it comes to labeling, even for cosmetics, which I would consider this a cosmetic treatment rather than medical.

"Alternative", "homeopathic" and "natural" remedies, which are likely categories that Mederma may fall into, are not as intensely regulated as "drugs" or "cosmetics." You'll get an ingredients list, but it's usually pretty useless or it will state on the label "these statements/daily allowances have not been evaluated by the FDA" ... typically in tiny print after an asterisk or dagger footnote.

Although, with the recent ruling against the makers of Airborne, those regulations may change. At least regarding advertising claims.

[~Katja~]

"Alternative", "homeopathic" and "natural" remedies, which are likely categories that Mederma may fall into, are not as intensely regulated as "drugs" or "cosmetics." You'll get an ingredients list, but it's usually pretty useless or it will state on the label "these statements/daily allowances have not been evaluated by the FDA" ... typically in tiny print after an asterisk or dagger footnote.

Although, with the recent ruling against the makers of Airborne, those regulations may change. At least regarding advertising claims.

yet the site claims loudly that it is pharmacist recommended. (right, not doctor but pharmacist)
Since it is a skin improving product I figured cosmetics would be best fit, being that it is made of onion extract it most likely will fall into "natural" remedies.

I wonder, there is this other cream (strivectin) they sell for stretch marks that was later discovered to be a "miracle" cream for wrinkles (:unsure:)
I wonder if that would help with regular scars as well.

[Thebazile78]

yet the site claims loudly that it is pharmacist recommended. (right, not doctor but pharmacist)
Since it is a skin improving product I figured cosmetics would be best fit, being that it is made of onion extract it most likely will fall into "natural" remedies.

I wonder, there is this other cream (strivectin) they sell for stretch marks that was later discovered to be a "miracle" cream for wrinkles (:unsure:)
I wonder if that would help with regular scars as well.

When I had my hand surgery, they only recommended that I keep the area moisturized if I was afraid of scarring. No recommendations on Vitamin E (although I was reading about the study Dr. Steve brought up on the internet at the time) or anything in particular, just moisturizer.

I still have a nasty scar, but nobody really notices it. It might be just the emollients in the moisturizers and the way folks' bodies heal rather than a direct causal relationship. Or maybe we want to believe that we've got control over these cosmetic flaws and the placebo effect takes over.

Some people use plain cocoa butter for stretch marks ... maybe that would help! (And, as a bonus, Tall_James would smell like the beach.)

[Tall_James]

(And, as a bonus, Tall_James would smell like the beach.)

Nice. Couple that with the Onion Extract in the Mederma and I'd smell like a fried clam shack.

And that ain't too shabby.