I was injured 2 months ago. After the removal of the stitches a normotrophic scar (about 1 cm long) is forming on my face. I would like to indirectly contribute to the skin and my constitution for minimizing scarring and optimal healing.
What vitamins (dietary supplements or some other substances) for internal taking will be useful for the skin? Thanks.
The process of wound healing is extremely complex and combines several processes that occur after the injury. According to 'Bioengineering In Wound Healing: A Systems Approach,'
These processes include coagulation, inflammation, angiogenesis, fibropalacia, epithelization, contraction, and remodeling.
Wound healing is not always a linear process, as it depends on multiple local, system, and environmental characteristics. When the healed wound completely restores the anatomy and function of the initial tissue,
the regeneration is complete and scarless.
However, fundamental conditions required for tissue regeneration are not favorable in mammals.
…the wound must close fast to enable survival and thus, in most cases in mammals, a tick fibrous tissue — a scar — is formed at the injured site.
Although several systemic and genomic studies have identified potential cellular and extracellular factors that mediate the formation of scars, the exact mechanism that induces proliferative scar tissue formation instead of healthy tissue is unknown.
Current data show that alterations in coagulation, inflammation, angiogenesis, fibroplasia, contraction, remodeling, mechanical tension correlate with the formation of scars.
Inflammation plays an important role in the body’s response to the injury and in all stages of wound healing.
The inflammatory response includes the response of local inflammatory cells and recruitment of inflammatory cells from the circulation.
Multiple studies show that inflammation continues to play a critical role in wound remodeling,
…probably leading to scar formation.
Wounds create damage at the system’s protective layer and provides a new, nutrient rich ground for microorganisms.
Microbiota play a role in both wound-healing abnormalities: chronic, non-healing wounds and hypertrophic scars, and also healing improvement.
Advances in molecular biology have allowed for an improved understanding of wound healing.
For optimal healing, complex molecular processes must be appropriate and precise.
The depth of injury is of particular interest as it determines if a wound heals with scarring or not.
Injury that is restricted to the epidermis is referred to as an erosion; if the injury were to go deeper, involving the dermis, then it is referred to as an ulcer…Erosions heal without scar, while dermal injury often heals with scar.
Many factors influence the time needed for a wound to heal…
…by secondary intention: wound depth (i.e. deeper wounds take longer than shallow wounds), anatomic location (e.g. concave surfaces do better than convex surfaces), vascular supply, shape (I.e. the narrower the diameter, the faster the closure), underlying comorbidities (e.g. Diabetes, tobacco use), and secondary infection...the balance between degradation and synthesis determines if a scar will be normal or abnormal.
Your "normotrophic" scar type is said to cause the least harm and typically forms as a result of an adequate reaction of the body to an injury. A chapter on Normotrophic Scars in the ‘Atlas of Scar Treatment and Correction’ states the following,
If the wound passes all stages of cicatrization without deviations, a normotrophic scar is formed. In time, such scars become level with the skin, assume a whitish color, become thin, and do not pose any physical discomfort to their bearers. Normally, they do not require correction except for aesthetic improvement of the scar appearance, its surface effacement, and acceleration of the color normalization process.
What vitamins (dietary supplements or some other substances) for internal taking will be useful for the skin?
There isn't one specific vitamin, supplement, or "some other substance" that is useful for the skin. However, your nutritional status in general can greatly influence wound healing, as wounds increase the energy, vitamin, mineral, and protein requirements necessary to promote healing. In fact, without adequate nutrition, the process of wound healing can actually be negatively impacted.
According to ‘Nutrition in Wound Care Management: A Comprehensive Overview.’
The role of nutrition in wound healing may be overlooked in the wound care patient…it is often multifaceted, with many nutritional components playing a variety of roles in the wound healing process. Suboptimal nutrition can alter immune function, collagen synthesis, and wound tensile strength, all of which are essential in the wound healing process.
The above abstract determined that nutrition is a common denominator for all wound patients, regardless of the type of wound. In summary,
…it appears that some nutrients are necessary only if deficient, whereas others may become conditionally essential and serve a therapeutic role.
Nutrition also influences skin structure. An abstract titled ‘The Effects of Dietary Macronutrient Balance on Skin Structure in Aging Male and Female Mice.’ evaluated the associations between macronutrients, energy intake, and skin structure in mice.
We evaluated the associations between macronutrients, energy intake and skin structure in mice fed 25 experimental diets and a control diet for 15 months using the Geometric Framework, a novel method of nutritional analysis.
Skin structure was associated with the ratio of dietary macronutrients eaten and the nature of the effect differed between the sexes.
In males, skin structure was primarily associated with protein intake, whereas in females carbohydrate intake was the primary correlate. In both sexes, the dermis and subcutaneous fat thicknesses were inversely proportional. Subcutaneous fat thickness varied positively with fat intake, due to enlarged adipocytes rather than increased adipocyte number. We therefore demonstrated clear interactions between skin structure and macronutrient intakes, with the associations being sex-specific and dependent on dietary macronutrient balance.
An abstract on 'Nutrition and Chronic Wounds' discusses nutrition as related to the patient with chronic wounds. The review provides knowledge of basic nutrition, the epidemiology of malnutrition in the chronic wound patient, and how to screen patients for malnutrition. It also recognizes that
…even obese patients may suffer from protein and micronutrient malnutrition.
Macronutrients are discussed in detail:
Macronutrients are defined by ASPEN Guidelines and Standards as “nutrients present in the body and required in the greatest amount (e.g., carbohydrates, proteins, lipids).” Amino acids are the building blocks of protein throughout the body. Some individual amino acids (arginine, glutamine, and methionine) have been supplemented in addition to the protein in the diet as adjunct pharmacologic nutrients for wound healing. Carbohydrates may be used to provide carbon skeletons for amino acid synthesis but only for those amino acids that are nutritionally dispensable (nonessential). Indispensible (essential) amino acids must be provided in the diet as a component of protein fed or as a keto-acid for all indispensible amino acids except lysine, threonine, and histidine. Fatty acids and cholesterol are nutrients that can be catabolized via beta oxidation to form cellular energy (ATP) and have important cellular functionality such as insulating membranes for nerve axons and are also necessary to form the lipid bilayer essential for organelle and cell membranes.
Micronutrients are also discussed in detail:
Micronutrients are defined as “nutrients present and required in the body in minute quantities (e.g., vitamins, trace elements).” Micronutrients include the vitamins and certain minerals. These minerals are often referred to as trace elements. Certain minerals, such as calcium, magnesium, and phosphorus (macrominerals), which are present in large quantities in the bone and other tissues, are not considered trace elements. One of the most common functions of micronutrients, and some macrominerals, is to serve as necessary cofactors for enzymatic reactions. Essential (or indispensable) nutrients are those that cannot be synthesized in the body, such as vitamin C and minerals.
'Nutrition Basics' by Washington State University, outlines specifics related to macro- and micronutrients including role in the body, recommended daily allowance, and food sources. This might be a useful resource in determining appropriate macro- and micronutrient related food choices that may promote wound healing and possibly reduce the appearance of scarring.
Additionally, 'The importance of patients’ nutritional status in wound healing,' concurs,
Wound healing is dependent on good nutrition and the presence of suitable polyunsaturated fatty acids in the diet. Protein deficiency has been demonstrated to contribute to poor healing rates with reduced collagen formation and wound dehiscence. High exudate loss can result in a deficit of as much as 100g of protein in one day. This subsequently needs to be replaced with a high protein diet. Vitamins are also important in wound healing. Vitamin C deficiency contributes to fragile granulation tissue.
Although it is possible that you may not achieve complete scar prevention, the information described above may provide some insight about the role of nutrition in wound healing and scar appearance. Because your injury is located on your face, it is also important to be conscious of simple facial movements, as this may also affect the healing process and contribute to scar formation. However, as with any health-related question or concern, it is always best to consult with your primary care physician or treatment specialist before making any drastic changes to your normal dietary regimen.
