Vitamins that may be helpful
Supplementation with bromelain, an enzyme
derived from pineapple stem, prior to and
following a surgical procedure has been shown to reduce swelling, bruising, healing time, and
pain.3 Bromelain supplementation has also been shown to accelerate the healing of
soft-tissue injuries in male boxers.4 The amount of bromelain used in these studies
was 40 mg four times per day, in the form of enteric-coated tablets. Enteric-coating prevents
the stomach acid from partially destroying the bromelain. Most currently available bromelain
products are not enteric-coated, and it is not known if such products would be as effective as
enteric-coated bromelain.
Thiamine (vitamin B1),5 pantothenic acid (vitamin B5),6 and other B
vitamins7 have all been shown to play a role in wound healing in animal studies.
For this reason, although human research is lacking, some alternative healthcare practitioners
recommend a high-potency B vitamin supplement to promote wound healing.
Vitamin C is needed to make collagen
(connective tissue) that strengthens skin, muscles, and blood vessels and to ensure proper
wound healing. Severe injury appears to increase vitamin C requirements,8 and
vitamin C deficiency causes delayed healing.9 Preliminary human studies suggest
that vitamin C supplementation in non-deficient people can speed healing of various types of
wounds and trauma, including surgery, minor injuries, herniated intervertebral discs, and skin
ulcers.10 11 A combination of 1–3 grams per day of vitamin C and
200–900 mg per day of pantothenic acid
has produced minor improvements in the strength of healing skin tissue.12
13
Zinc is a component of many enzymes,
including some that are needed to repair wounds. Even a mild deficiency of zinc can interfere
with optimal recovery from everyday tissue damage, as well as from more serious
trauma.14 15 One controlled trial found the healing time of a surgical
wound was reduced by 43% with oral supplementation of 50 mg of zinc three times per day, in
the form of zinc sulfate.16
Whether oral zinc helps tissue healing when no actual zinc deficiency exists is
unclear,17 but doctors often recommend 30 mg of zinc per day for four to six weeks
to aid in the healing of wounds. Topical zinc-containing treatments, on the other hand, have
improved healing of skin wounds even when there is no deficiency.18 19
Long-term oral zinc supplementation must be accompanied by copper supplementation to prevent a
zinc-induced copper deficiency. Typically, if 30 mg of zinc are taken each day, it should be
accompanied by 2 mg of copper. If 60 mg of zinc are used, it should be accompanied by 3 mg of
copper each day.
Preliminary20 and controlled21 studies of people with severe burns
and other types of injuries22 showed that supplementation with 10–30 grams of
ornithine alpha-ketoglutarate (OKG) per day
significantly improved wound healing and decreased the length of hospital stays. Improved
healing from major trauma and surgery has also been demonstrated with oral supplements
including several grams per day of
glutamine.23
Vitamin A plays a central role in wound
healing,24 but the effect of supplemental vitamin A in people who have suffered a
minor injury and are not vitamin A-deficient remains unclear. Vitamin A supplements have been
shown to improve healing in animal studies,25 and may be especially useful in a
topical ointment for skin injuries in people taking corticosteroid medications.26 Although
there are no studies in humans, some doctors recommend 25,000 IU of vitamin A per day,
beginning two weeks prior to surgery and continuing for four weeks after surgery.
Animal studies have shown that supplementing with vitamin E can decrease the formation of unwanted
adhesions following a surgical wound. In addition, wound healing was more rapid in animals fed
a vitamin E-rich diet than in those fed a standard diet.27 In another study,
however, wound healing was inhibited by supplementation with a massive amount of vitamin E
(equivalent to about 35,000 IU).28 This adverse effect of vitamin E was prevented
by supplementation with vitamin A. Although the relevance of these studies to humans is not
clear, many doctors recommend supplementing with both vitamins A and E in order to enhance
wound healing and prevent adhesion formation. Typical amounts recommended are 25,000 IU of
vitamin A per day and 400 IU of vitamin E per day, beginning two weeks prior to surgery and
continuing for four weeks after surgery.
Topical application of vitamin E is sometimes recommended for preventing or treating
post-injury scars, although only three controlled studies have been reported. Two of these
trials found no effect on scar prevention after surgery,29 30 and one
trial found vitamin E improved the effect of silicon bandages on large scars called
keloids.31
Copper is a required cofactor for the
enzyme lysyl oxidase, which plays a role in the cross-linking (and strengthening) of
connective tissue.32 Doctors often recommend a copper supplement as part of a
comprehensive nutritional program to promote wound healing. A typical amount recommended is
2–4 mg per day, beginning two weeks prior to surgery and continuing for four weeks after
surgery.
Other trace minerals, such as manganese, copper, and silicon, are known to be important in the biochemistry
of tissue healing.33 34 35 36 However, there have
been no controlled trials exploring the effect of oral supplementation of these minerals on
the rate of healing.
Topical application of hyaluronic acid and
related compounds is sometimes used in skin wound dressings to improve healing.37
One controlled trial found a hyaluronic acid compound helpful for healing skin ulcers
associated with chronic venous insufficiency.38 Improved healing of nasal surgery
wounds with topical hyaluronic acid was reported in one controlled study,39 but not
in another.40 A double-blind study found improved healing of perforated eardrums in
patients using drops of 1% sodium hyaluronate.41 Whether oral hyaluronic acid
supplements might improve wound healing has not been investigated.
Glucosamine sulfate and chondroitin sulfate may both play a role in wound
healing by providing the raw material needed by the body to manufacture connective tissue
found in skin, tendons, ligaments, and joints.42 Test tube and animal studies have
found that these substances, and others like them, can promote improved tissue
healing.43 44 45 46 47 One controlled
trial in humans found that wounds healed with greater strength when they were treated
topically with a chondroitin sulfate-containing powder.48 However, no research has
investigated the value of oral supplements of glucosamine or chondroitin for wound healing in
humans.
Arginine supplementation increases protein
synthesis and improves wound healing in animals.49 Two controlled trials have shown
increased tissue synthesis in surgical wounds in people given 17–25 grams of oral
arginine per day.50 51
Carnosine is a small molecule composed of
the amino acids histidine and alanine. The exact biological role of carnosine is not
completely understood, but animal research demonstrates that it promotes wound
healing.52 More research is warranted in this area.
Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.
Herbs that may be helpful
While many herbs may be useful in wound healing, it is important that wounds be properly
cleaned and dressed before any herbal preparations are applied. This will prevent
infection.
In animal studies of skin inflammation, both topical and oral aloe vera have proven beneficial in decreasing
inflammation and promoting cellular repair.53 54 Topical aloe vera has
facilitated wound healing in controlled human research, as well.55 In one
controlled trial, however, topical aloe vera gel was inferior to conventional management of
surgical wounds.56
One preliminary trial found that a gotu
kola extract helped heal infected wounds (unless they had reached bone).57 A
review of French studies suggests that topical gotu kola can help wounds.58 One
study found gotu kola extract helpful for preventing and treating enlarged scars
(keloids).59 Standardized extracts of gotu kola containing up to 100% total
triterpenoids are generally taken, providing 60 mg once or twice per day. Animal studies have
shown that constituents in gotu kola, called asiaticosides, increase antioxidant levels during
wound healing and facilitate repair of connective tissues.60 61
Horse chestnut contains a compound called
aescin that acts as an anti-inflammatory and reduces edema (swelling with fluid) following trauma,
particularly sports injuries, surgery, and head injury.62 A topical aescin
preparation is popular in Europe for the treatment of acute sprains during sporting
events.
A topical preparation of chamomile combined
with corticosteroids and antihistamines has
been used to speed wound healing in elderly people with stasis ulcers caused by inadequate
circulation,63 as well as in people who had tattoos removed.64 Topical
use of chamomile ointment was also found to successfully treat mild stasis ulcers in elderly
bedridden patients.65
Topical application of honey has been used since antiquity to accelerate skin wound
healing.66 Honey has been shown to inhibit the growth of several organisms
responsible for wound infections.67 68 69 In one preliminary
study, nine infants with large, open infected wounds that failed to heal with conventional
treatment were treated successfully with topical application of honey.70 Fresh
unprocessed honey was applied to wounds in amounts of 5–10 ml twice daily for a period
of 21 days. All infants showed marked clinical improvement after 5 days, and the wounds were
closed and free of infection by 21 days. The
use of honey to treat wounds should be supervised by a doctor.
Used topically, some practitioners consider arnica to be among the best vulnerary
(wound-healing) herbs available.71 Topical use of arnica is approved by the German
government for improving wound healing.72 Arnica is poisonous if taken
internally.
Calendula flowers were historically
considered beneficial for wound healing, reducing inflammation and fighting infection as a
natural antiseptic.73 Like
echinacea, calendula is approved in Germany for use in treating poorly healing
wounds.74 Generally 1 tablespoon (15 grams) of calendula flowers is steeped in hot
water for 15 minutes, then cloths are dipped into the liquid to make compresses. Such
compresses should be applied for at least 15 minutes, initially several times per day, then
tapering off as the wound improves.
Traditional herbalists sometimes recommend the topical use of herbs such as St. John’s wort, calendula, chamomile, and plantain, either alone or in combination, to speed
wound healing. Clinical trial in humans have not yet validated this traditional practice.
Echinacea is used among European
practitioners of herbal medicine to promote wound healing75 and is approved by the
German government for this use.76 Creams or ointments are applied several times a
day to minor wounds.
Comfrey has anti-inflammatory properties
that may decrease bruising when the herb is applied topically.77 Comfrey is also
widely used in traditional medicine as a topical application to help heal wounds.78
Witch hazel can also be used topically to
decrease inflammation and to stop bleeding.79 Native Americans used poultices of
witch hazel leaves and bark to treat wounds, insect bites, and ulcers.80 Horsetail can be used both internally and topically to
decrease inflammation and promote wound healing.81
Chaparral has been used topically to
decrease inflammation, and pain, and promote healing of minor wounds.82 For topical
use, cloths can be soaked in oil preparations or tea of chaparral and applied several times
per day (with heat if helpful) over the affected area. Powdered chaparral can be applied
directly to minor wounds, after they have been adequately cleansed.
Alginic acid is one of the main constituents in bladderwrack (Fucus vesiculosus), a type of
brown algae (seaweed). Calcium alginate has shown promise as an agent to speed wound healing
in animal studies83 but has not been demonstrated to be effective in humans.
Australian Aboriginals used the leaves of tea tree to treat cuts and skin infections,
crushing and applying them to the affected area. Modern herbalists recommend tea tree oil (at a strength of 70–100%) applied
moderately in small areas at least twice per day to the affected areas of skin.84
For a variety of reasons, some researchers have suggested that tea tree oil should not be used
to treat burns.85
Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.
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