Nutritional support for wound healing

Alternative Medicine Review, Nov, 2003 by Douglas J. MacKay, Alan L. Miller

Since the discovery of vitamin E as the major lipid-soluble antioxidant in skin, it has been used topically for a wide variety of skin lesions. Anecdotal reports claim topical vitamin E is valuable for speeding wound healing and improving cosmetic outcome of burns and other wounds, including surgical scars. Such claims are disputed by two human clinical trials. In a double-blind study of 15 patients with surgically-induced wounds, emollient lotion and emollient lotion mixed with vitamin E were applied to healing wounds. The wounds were randomly divided into two parts and the different topical applications were applied to the same half of each wound twice daily. Physicians and patients independently evaluated the scars for cosmetic appearance on weeks 1, 4, and 12. In 90 percent of cases, topical vitamin E either had no effect, or actually worsened the cosmetic appearance of scars. (58) In addition, 33 percent of the patients studied developed contact dermatitis to topical vitamin E. A response to this study, published in Dermatologic Surgery., pointed out that d-alpha tocopherol is an extremely unstable compound, rendering details of its source, formulation, storage condition, and stability over time critical to interpretation of this study. It was also noted that breakdown products and contaminants could account for the inflammatory response encountered. (59) In a second, larger blinded study, the effects of topical steroids, vitamin E, or the base cream carrier for these substances on scar outcome of 159 post-operative patients were evaluated. Both topical steroids and topical vitamin E failed to impact scar thickness, range of motion, or ultimate cosmetic appearance. (60)

The available data on vitamin E and wound healing could lead to several possible conclusions: (1) systemic vitamin E may have a negative impact on surgical wounds due to its lysosomal-stabilizing properties; (2) vitamin A may mitigate these negative effects; and (3) hydrophilic and hydrophobic preparations of vitamin E may have different actions related to wounds. The benefit of topical vitamin E on surgical wound healing and scar formation remains inconclusive and, although anecdotal reports support topical use of vitamin E for scar therapy, research shows it may have a negative effect on scarring and wound outcome.

Other Dietary Supplements and Wound healing

Bromelain

Bromelain is a general name given to a family of proteolytic enzymes derived from Ananas comosus, the pineapple plant. Throughout the 1960s and 1970s a series of studies found the effects of orally administered bromelain include the reduction of edema, bruising, pain, and healing time following trauma and surgical procedures. (61-64) More recently, researchers from the Czech Republic found that patients with long bone fractures administered a proteolytic enzyme combination containing 90 mg bromelain per tablet had less post-operative swelling compared to patients given placebo. (65) Fractures were treated by surgically inserting rods through the long axis of the fractured bone (intramedullary fixation) or by constructing an external framework of pins and rods going through the skin and muscle to connect to the fractured bone (external fixators). The treatment group was given three 90-mg tablets three times daily for three days after surgery and, subsequently, two tablets three times daily for two weeks. On the fourteenth post-operative day the limb volume of the treatment group was reduced by 17 percent compared with nine percent in the control group. The total number of analgesics consumed by the treatment group was also significantly reduced in comparison to the control group. (65)