Saturday, March 29, 2014

Beauty Myths: Vitamin E and Scarring

Vitamin E as a treatment for scar tissue is a tale as old as time. Sadly, it's no more based on reality than turning into a hairy monster because you were mean to a witch. Despite the damning evidence that you probably should not put Vitamin E on a scar, this myth continues to bounce around, particularly on sites that advocate for home remedies and on sites about body piercing and modification.

Before I start, I want to clarify that there is nothing wrong with using a cosmetic product that contains Vitamin E. I am specifically debunking the idea that you should be putting Vitamin E on scar tissue. Additionally, although post-inflammatory hyperpigmentation is colloquially referred to as "acne scarring", it is not actually a scar and there is no evidence that putting Vitamin E on hyperpigmentation is anything put benign.

What Are We Talking About?

So, what the hell is Vitamin E, anyways? In general, vitamins are organic compounds that the human body requires. (This contrasts with minerals, like calcium or potassium, which may also be required, but are inorganic.) Vitamin E is the name for eight different fat-soluble compounds, four of which are tocopherols and four of which are tocotrienols.

Alpha-tocopherol
Image Source: http://en.wikipedia.org/wiki/File:Tocopherol,_alpha-.svg

When Vitamin E is added to topical cosmetics, it is usually in the form of tocopherol acetate. (Tocopheryl linoleate and tocopheryl nicotinate are also used cosmetically.) A wide variety of skincare companies make products featuring Vitamin E, including the Body Shop and Malin + Goetz, where it is typically touted as an antioxidant.

Secondly, what is a scar? I've written about scar tissue in more depth here, but a quick-as-a-motherfucker review: A scar is the fibrous tissue that your body may produce post-injury.

Why Do People Think Vitamin E On Scar Tissue is a Good Idea?

According to Baumann and Spencer (1999), "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." In other words, part of the craze is just because it's there. And, like, antioxidants and stuff.

However, as with many home remedies, there is some scientific reasoning behind the remedy.

Most notably, in vitro evidence shows that Vitamin E inhibits fibroblasts and keratocytes in both humans and rabbits. In particular, Vitamin E increases the levels of a cytokine called basic fibroblast growth factor (bFGF), which inhibits collagen production, an important part of scar formation. 'Bingo bango!' thought home remedy advocates. 'Vitamin E equals less collagen scar formation!'

Fibroblasts
Image Source: http://crm.nih.gov/stemcell_types/ESC_iPSC/images/fibroblast_D2.jpg

And that would seem true, if we didn't have any other evidence.

In vitro experiments, or "test tube experiments", which take place when you isolate a cell or tissue culture from the organism at hand. They are awesome because they let us look a lots of tiny parts individually without getting distracted by a bunch of irrelevant stuff. It's simple and an essential part of biological science.

But here's the thing: being able to predict the levels of bFGF in a petri dish don't always mean a crapload when what we really want is to extrapolate and talk about a big, honking, on-a-living-body scar. That's why in vivo evidence on an actual set of humans is so important when determining the efficacy of cosmetics ingredients.

Why Is This Actually a Terrible Choice?

We do, in fact, have that in vivo evidence.

Vitamin E, when applied topically to scar tissue, does not improve scar healing. Indeed, it actually results in a pretty worrisome number of minor but troublesome side-effects.

Jenkins and colleagues (1986) tracked 159 burn victims for one year. Participants were randomly assigned to be treated using a Vitamin E cream, a topical steroid cream, or a base cream containing nothing of note. The researchers assessed range of motion, scar thickness, change in graft size, and ultimate cosmetic appearance of the scar. They found no effects of either the topical steroid or the Vitamin E on any of their assessed factors and concluded that neither treatment was effective at reducing scar formation. What's more, 20% of those receiving the Vitamin E treatment reported some form of adverse side effects as a result of the application.

A later double-blind study by Baumann and Spencer (1999) had similar results. Skin cancer patients who had undergone surgery to remove their lesions were given two ointments labeled A and B, one of which contained Aquaphor, a traditional emollient, and one of which contained Aquaphor mixed with vitamin E. Scars were then randomly divided into part A and B. Participants were instructed to put Ointment A on part A of the scar and the Ointment B on part B of the scar twice daily for 4 weeks. Scar appearance was independently assessed by the patient, the physician, and a trained investigator. Instead of finding a beneficial effect of the Vitamin E on scar tissue, researchers concluded that "the application of topical vitamin E may actually be detrimental to the cosmetic appearance of a scar." Furthermore, 33% of the participants developed contact dermatitis, a form of skin inflammation, as a result of the Vitamin E exposure.

Image Source: http://healthpsych.psy.vanderbilt.edu/2010/VitamineE_files/image002.png
Zurada, Krigel, and Davis (2006) add that even the in vitro justification for Vitamin E on scar tissue may be flawed. They note, "The use of vitamin E in scar management has other theoretic limitations. Because of its ability to inhibit collagen synthesis, the use of vitamin E early in scar therapy may reduce scar tensile strength and, hence, lead to the development of widened scars and even wound dehiscence."

If the Evidence Isn't There, Why Does This Rumor Keep Showing Up?

In my opinion, part of the reason this home remedy refuses to die is because people cannot run a double-blind experiment on themselves... but scars do fade, no matter what you put on them. If someone hears about Vitamin E, uses it, and ends up with a faded a scar, even if it had nothing to do with the Vitamin E, they might continue to recommend it.

This is one of the reasons it is so important to check out what the scientific literature says on an ingredient, rather than relying on user testimonials.

21 comments:

  1. Nice post. I recently found this information out, which was too little too late as I was advised to use this on my hideous scar :/

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    1. With my scars, I have taught myself to think up daring, adventurous and hyperbolically unreasonable tales of how I got them, and then hope that they will diminish naturally in time. :-D

      This is an excellent post, as always, Robyn!

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    2. That's so funny! I do the same thing. When people ask, I say I broke up a monkey knife fight and was sliced in the process. You should see the look on their faces. :)

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    3. Everyone presumably thinks y'all are badasses.

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    4. Well, mine actually is a chainsaw scar inflicted by my sister, so at least there's that.

      (Just discovered your blog and have been devouring the archives. Good stuff, Robyn!)

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  2. Vitamins have become a pet peeve of mine lately. Great article and great use of the literature, as usual.

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    1. There's definitely a lot of funky information about vitamins out there!

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  3. I have a question: should stretch marks be treated the same as any other scar? And are there then any advantages at all to the use of vitamin E besides on scar tissue? Anyway, excellent article, as always!

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    1. I dont know about its affect on stretch marks, but it doesn't sound like vitamin e helps at all topically.

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    2. I would not recommend Vitamin E on stretch marks, no.

      Vitamin E is an antioxidant, but, in my opinion, you're better off ensuring that you get adequate amount in your diet than rubbing it on your face.

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    3. I was wondering this too. There is a study which indicates Vitamin E cream may help you stop developing stretch marks, but I'm sure if it's great research or not. http://www.ncbi.nlm.nih.gov/pubmed/10796111?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

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    4. Interesting! This research is all on already-present scars, so that's a good thing to keep in mind.

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  4. Oh god yes. The vitamin E/scarring myth is one of my pet hates, up there with cocoa butter/stretch marks and pretty much everything/stronger hair.

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    1. Oh gosh, I haven't heard the cocoa butter/stretch marks one in ages, haha. That was used a lot by people around puberty, when people are growing all sorts of weird ways.

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  5. Phenomenal post ! I tell my clients the glycerine in the capsule is probably doing all the work, so may as well get something that is truly meant for scars.

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  6. Love this post! I recently burned my forearm pretty badly with a curling wand, and used vitamin E oil on it - and promptly got the most hideous, itchy, red, bumpy rash in about a two inch diameter all around the burn itself. NOT a good thing!

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    1. Uh oh! I hope you got to go to a dermatologist!

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  7. Disclaimer: it's almost 3 am and I really want to comment before I fall asleep. I've read that the main problem with topical vitamin E is that it needs to have plenty of free radicals to scavenge, otherwise it seems to get bored and become devious, for lack of a better description, and morphs into an evil pro-oxidant and starts acting like a free radical wreaking havoc all over your skin cells. I can't remember/don't fully understand the chemistry, but somehow vitamin E's evil tendencies can be controlled/balanced by combining it with vitamin C, some forms of which are delightfully unstable. Like everything else in the world, more isn't always better. The home remedy/anecdotal evidence crowd seems to be fond of assuming that if 1% of something is good for your skin and/or body, 100% must be better, which is almost never the case. Vitamin E is usually 0.5-1.0% of a formula, maybe 2% maximum. Applying 100% of anything that is ordinarily used at a less than 2% concentration would probably be a recipe for disaster. My skincare myth pet peeve: lemon juice and sugar/salt facial scrubs. Witch hazel and rubbing alcohol toners would be a very close second. I think I got a rash just from thinking about those combinations. *shiver*

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    1. Vitamin E molecules don't contain unpaired electrons, so there is no reason that they should work as free radicals. And although it may be true that concentration is important, the research cited here doesn't involve putting 100% Vitamin E on the skin...

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