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The Role of Vitamin E in Wound Healing and Scarring
Submitted by AC Grace

Surgery, cosmetic procedures, and injuries create trauma or damage to the skin. The proper healing of the resulting wound is critical to the final appearance and the degree of scarring. Wound healing proceeds in three phases:

• Inflammatory phase, which begins immediately after the operation. During this phase, bleeding stops, white blood cells fight bacterial infection, and collagen formation begins.


• Proliferative phase, which lasts several weeks. Collagen continues to be produced and new capillaries (tiny blood vessels) are formed to aid in healing.

• Remodeling or maturation phase, which continues for a period from several weeks to several years. More collagen is first produced to strengthen the wounds, and then excess collagen is removed to form a thin, flat, white scar.

Three critical factors in wound healing and scarring
Inflammation, nutritional status, and immune system are all critical to proper healing of the skin. It is well known that smoking, poor nutritional status, and a weak immune system contribute directly or indirectly to poor wound healing. The emerging science, however, points to the direct and critical role of inflammation. Controlling inflammation, which is closely related to nutritional status and immune system function, is the key strategy for accelerated wound healing and minimal scarring.

Free radicals are major culprits in inflammation
Surgery, laser treatment, and many cosmetic treatments increase the production of free radicals – extremely reactive and harmful molecules. Free radicals damage collagen, proteins, and lipids, key components in wound healing. Excess production of free radicals causes oxidative stress, a condition that weakens the immune system, accelerates aging, and increases the risk of chronic diseases.

The critical role of nitric oxide in healing and inflammation
Since its discovery, 20 years ago, which resulted in the award of the Nobel Prize, nitric oxide was shown to play an important role in wound healing. Nitric oxide affects diverse mechanisms involving inflammation, angiogenesis, and cell proliferation. Immune system chemical messengers, known as cytokines, control these processes; in many cases, nitric oxide appears to modulate these cytokines, especially those associated with inflammation. In addition, nitric oxide is an important component of the immune system which fights infection.

While extremely useful at normal and modestly elevated amounts, nitric oxide produced in excess can have devastating effects. For example, uncontrollable production of nitric oxide during infection causes sepsis, a potentially fatal condition. In less severe conditions, excess amounts of nitric oxide lead to increased production of nitrogen radicals, which accentuate inflammation and further production of nitric oxide and free radicals. Controlling inflammation and oxidative stress (from excess production of free radicals and especially nitrogen radicals) is key to accelerated wound healing and minimized scarring.

Facts about vitamin E and the special role of gamma tocopherol and tocotrienols
• Natural vitamin E is composed of eight compounds: four tocopherols and four tocotrienols.

Vitamin E is the collective name for its set of the eight related isomers: alpha-, beta-, gamma-, and delta-tocopherol; and alpha-, beta-, gamma-, and deltatocotrienol; which are fat-soluble vitamins.

• All forms of tocopherols and tocotrienols have antioxidant capabilities, but tocotrienols display up to 50 times greater antioxidant potential than tocopherols.

• Gamma-tocopherol, along with its metabolite produced in the body, is an effective quencher of nitrogen radicals and an effective anti-inflammatory.

• Research by the Armed Forces Radiobiology Research Institute (AFRRI) showed that tocotrienols, particularly gamma and delta forms, provide powerful protection against radiation damage.

• Alpha-tocotrienol is being evaluated in a clinical study for its wound healing properties.

Tocotrienols accumulate preferentially in the skin.

For most vitamins, natural or synthetic makes little difference; however, it's critical to use only the natural, full-spectrum form of vitamin E. Most vitamin E supplements contain only alpha tocopherol because it was thought that only this one form was important. Even worse, most vitamin E skin products contain a small amount of synthetic dl-alpha-tocopheryl acetate. This means that they contain only one of the eight members of the vitamin E family in the less effective, synthetic form. They do not contain gamma tocopherol and tocotrienols. In addition, its active group is blocked and cannot fight the free radicals on the surface of the skin.

Additional skin healing nutrients:
• The powerful antioxidant potential of tocopherols and tocotrienols described above can be strengthened by the synergistic antioxidant activity of other components such as carotenoids, vitamin A, and natural antioxidants. Vitamin A and its natural metabolites affect epithelial cell proliferation and differentiation, immune modulation, angiogenesis, and are used to treat acne, photoaging, and biologic skin aging.

Vitamin D3 modulates the peptides kallikrein and cathelicidin, which have antibiotic and immunomodulator properties including rosacea and psoriasis.


Vitamin E, A, and D3 can benefit the following conditions:
• Wounds caused by minor burns including burns from exposure to UV radiation (sunlight).

• Skin ulcers often associated with chronic disease such as diabetes.

• Skin damage caused by physiological conditions such as pregnancy (stretch marks) and exposure of the skin to pollutants, chemicals, and radiation.

• Protection of the skin from the damaging effects of radiation, thus reducing photoaging, which is a major cause of the aging of the skin.

References:
1. Proc Natl Acad Sci U S A 1993;90:1771-1775.
2. J Intraven Nurs. 2001;24:124-32.
3. Proc Natl Acad Sci U S A. 2000;97:11494-11499.
4. Free Radic Biol Med. 2008;45:40-9.
5. Radiat Res. 2010;173:738-47


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