Tocopherol: on scars it did not help, and 33% developed contact dermatitis

The 1999 trial has a very clean design. The scars of fifteen patients who had undergone skin cancer excision were divided into parts A and B. Part A got a plain emollient ointment (Aquaphor); part B got the same ointment mixed with vitamin E, twice daily for four weeks. Double-blinded, and the comparison happens within one person's own scar.

At weeks 1, 4 and 12 the physician and the patient each judged independently which side looked better, and a third blinded investigator reviewed photographs.

The results, in the authors' own words:

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.

And the conclusion: use of topical vitamin E on surgical wounds should be discouraged.

This is a small trial of fifteen people. It cannot settle the matter alone, which is why the 2016 systematic review sits beside it.

That review took prospective studies only and found six. Three reported significant improvement in scar appearance (one used vitamin E as monotherapy in white children; two used it as combination therapy in adults), and the other three found no significant improvement with monotherapy. Two of the six reported adverse events: contact dermatitis, and increased itching and rash.

The authors' conclusion: there is not yet sufficient evidence that monotherapy with topical vitamin E has a significant beneficial effect on scar appearance to justify its widespread use.

This is why the item is graded 'not established'. Not because nobody looked — because people looked and it did not hold up.

The 2009 study is unusual for a specific reason. It separates 'the ingredient entered the skin' from 'the ingredient worked', inside one trial.

The contralateral arms of volunteers with actinic keratoses were randomly assigned: 12.5% DL-alpha-tocopherol cream on one, placebo cream on the other, for six months.

Absorption was not in doubt. Plasma concentrations did not change, but skin levels were highly elevated (P < .001). What was applied crossed the stratum corneum and reached tissue.

The lesions, however:

• The number of actinic keratoses declined insignificantly in both the placebo and treatment arms.
• p53 protein expression and proliferating cell nuclear antigen did not change significantly.
• Polyamines (putrescine, spermidine, spermine and total) did decrease significantly.

The authors' sentence: six months of application did not significantly reduce the number of pre-existing actinic keratoses. They add that the polyamine reductions are directionally consistent with inhibiting tumour formation.

How to read this matters. In cosmetic writing, 'penetration' is often used as if it were evidence of effect. This trial shows, on one person's two arms, that penetration can be confirmed and the outcome still not move.

One fact is worth knowing when you see tocopherol on a label.

Tocopherol is a lipid-soluble antioxidant, and so it is used very widely to stop the oils in a product going rancid. The small amount of tocopherol in an oil, a balm or a cream is usually there for that.

The same ingredient can be doing two jobs — protecting the product, or doing something to skin. An ingredient list does not tell you which. You can only guess from position, and one line near the bottom usually means the former.

So 'contains vitamin E' on a package often has no connection to the trials above. Those used concentrations chosen for effect — the 2009 trial used 12.5%.

Formulas pairing it with vitamin C are also common, on the account that the two regenerate each other. What has been shown for that combination in human skin is covered separately on this site's ascorbic acid page.