Vitamin E Ointment
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We first used Alpha Tocopherol in ointment form for indolent ulcers in 1947, but did not report its use for superficial wounds until the next year.
The oral administration of alpha tocopherol should be begun simultaneously with the topical ointment, since, while either alone may be effective, one complements the other. Open wounds so handled, whether traumatic or ascribable to prolonged decubitus, heal faster, with less scar-tissue contraction, with a more pliable subcutaneous layer and with less tender surface covering, than do such wounds treated in any other way. The usefulness of alpha tocopherol ointment in burns, whether thermal in origin or due to X-ray or radium, has also been demonstrated. Noteworthy is the limitation of necrosis so achieved in thermal burns and this even in severe cases. Prompt application is essential, of course. First-degree burns so treated may almost disappear in two or three days. As we have pointed out elsewhere, there is a singular freedom from infection, toxemia, and contracture which of ten makes skin-grafting unnecessary.
Incidentally, this ointment is excellent for small domestic burns and has a very practical application in the inconvenient, uncomfortable, and very common sunburn.
Elsewhere we have reported the ability of oral alpha tocopherol to improve the circulation in limbs showing small areas of gangrene. By its means the viable tissues just proximal to the dead cells can, by the usual process of capillary budding and phagocytosis of dead cells with liquefaction, separate necrotic from living tissue at the zone of separation. Healing of the raw subgangrenous areas left when the gangrenous patches detach themselves can be accelerated by the local use of tocopherol ointment.
Recalling the early studies of Steinberg, lumbago was early treated by us with inunction of tocopherol ointment over the affected area, followed by heat. Within an hour or so pain and disability could disappear. We have used this treatment on many cases of fibrositis and myositis. The discovery that alpha tocopherol in ointment form apparently penetrated intact skin, and might have a direct effect upon underlying joints, led to trials of this agent on a variety of conditions where diminished blood supply or decreased tissue oxygenation could be a part of the picture. Thus we have seen a few cases of rheumatoid arthritis in which the swelling and pain in the joints were materially reduced and mobility increased. One such patient who had been nearly immobile for 18 months returned to normal activity with residual flexion deformity in but three joints. The ointment, rubbed into fingers showing rheumatoid arthritis, can be especially helpful. Not all cases respond, of course, and our experience is relatively limited.
The ointment is of real value in relieving the itching of the abdominal skin associated so often with striae gravidarum and for pruritis ani or vulvae and even for the irritation of keloids.
A field in which our experience has been extensive is that of chest pain of non-cardiac origin. So often in right-handed persons there is pain in the left chest wall, most frequently found in the fourth or fifth interspace, accompanied by tenderness on pressure between the ribs which may extend around to a point just lateral to the spinous processes of the vertebral bodies. This pain may closely simulate true angina pectoris, since exertion and any resultant deep breathing may irritate the lesion and evoke the pain.
It can usually be differentiated from true angina by the fact that it begins with a change in position on sitting in a too-easy chair or on lying on a too-soft mattress, is tender, and is aggravated by coughing, twisting, or even deep breathing. it is frequently misdiagnosed and can even be labeled status anginosus. The variety of terms applied to this condition is evidence of its interest, e.g., intercostal neuritis, spondylitis, even arthritis of the spine. Vitamin E ointment, gently rubbed in for ten minutes, followed by heat for ten minutes and applied to the paravertebral area only, will relieve the pain in one to three days in many cases. Thiamin chloride, given orally or by injection, is very valuable, of course. We often recommend manipulation and note with interest that a recent report has commented favorably on such treatment.
In 1949 Scardino and Hudson reported the beneficial effect of oral alpha tocopherol on Peyronie's disease. We have seen a few such cases co-incidentally in patients under treatment with vitamin E for cardiac conditions. Some have reported improvement, rarely complete; some have no improvement; none have worsened. In one ease we suggested that it might be possible to increase the concentration of alpha tocopherol locally by the use of the ointment and heat. It should be noted that this patient has been ingesting a large dosage of alpha tocopherol daily for three years, the status of the Peyronie's disease remaining the same. Using tocopherol ointment the condition improved greatly in three months.
Finally, we wish to report the use of tocopherol ointment in a case of recurring corneal ulcer, in the hope that this suggestion may be tested further by ophthalmologists. A man has been under our care since June, 1954, for intermittent claudication and accordingly has been given 300 to 1,600 units of alpha tocopherol daily.
In May, 1957, while taking 750 units daily, he developed a recurrent corneal ulcer for the sixth time since 1940. Originally, a piece of radium paint from an aircraft instrument had flown into his eye, and the resulting ulceration had been treated by an ophthalmologist for six weeks. Originally, and during the ensuing four attacks, ophthalmic ointments of several types and oral and parenteral antibiotics had failed to heal the ulcer until it was cauterized. When this sixth recurrence was noted, we decided to instill half-strength tocopherol ointment. Two days later full strength ointment was applied. The lesion healed in two weeks, and there were no untoward effects from the introduction of the ointment into the eye. No previous observation of this sort has been found in the literature. We may add that his sight has not worsened appreciably with this last episode.
We occasionally see an indolent leg ulcer in which the ointment increases local irritation or even provokes an id rash. Perhaps a dilute ointment containing 15 international units of alpha tocopherol per gram should be used initially on such patients and should be applied on limited areas. If that causes no general or local reaction but does not promote healing in the lesion, then a stronger tocopherol ointment can be used safely.
Source: Vitamin E For Ailing And Healthy Hearts
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