Commentary
Carol Rolling, PharmD
The potential benefit of vitamin A in wound healing is based on its role in maintenance of normal epithelial tissue structure and stimulation of epithelialization and collagen synthesis. However, vitamin A in excess is toxic and teratogenic. The liver, skin, central nervous system, and musculoskeletal system can be adversely affected by excess vitamin A. Thus, potential benefits and risks must be balanced when considering vitamin A supplementation in patients without a documented deficiency. Unfortunately, few well-designed studies in humans are available to determine who is likely to benefit from vitamin A supplementation, who might be harmed, and the doses at which benefit and harm occur.
Patient populations with a high prevalence of suboptimal vitamin A status (those with Crohn’s disease, chronic gastrointestinal disease, alcoholic or primary biliary cirrhosis, pancreatic insufficiency, and chronic corticosteroid use)1 would seem most likely to benefit and least likely to be harmed; yet there are little or no data on which to base a safe dose and duration of therapy. Cirrhosis Photomicrograph of vitamin A has been reported in as little as 6 months with the 25,000 IU (7500 µg retinal activity equivalents [RAE]) of vitamin A daily by mouth, suggested for wound healing.2,3 Therefore, it would seem prudent to limit the duration of vitamin A supplementation for wound healing to a maximum of a few weeks.
References:
1. Russell RM.The vitamin A spectrum: from deficiency to toxicity. Am J Clin Nutr. 2000;71:878-884.
2. Geubel AP, De Galocsy C,Alves N,Rahier J,Dive C.Liver damage caused by therapeutic vitamin A administration:estimate of dose-related toxicity in 41 cases. Gastroenterology. 1991;100:1701-1709.
3. Scholl D, Langkamp-Henken B. Nutrient recommendations for wound healing.J Intraven Nurs. 2001;24:124-132.
[PRINTER FRIENDLY VERSION]
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