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Lack of the effect of topical vitamin K on bruising after mechanical injury

2004; Elsevier BV; Volume: 50; Issue: 6 Linguagem: Inglês

10.1016/j.jaad.2004.01.057

1097-6787

Réka Kovács, László Bodai, A. Dobozy, Lajos Kemény,

Nail Diseases and Treatments

Bruising occurring after laser treatment is a significant problem in cosmetic dermatology. Although vitamin K creams are widely used for prevention and treatment of purpuras, there is no direct evidence to prove their efficacy. Shah et al1Shah N.S Lazarus M.C Bugdodel R Hsia S.L He J Duncan R et al.The effects of topical vitamin K on bruising after laser treatment.J Am Acad Dermatol. 2002; 47: 241-244Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar found that pretreatment with vitamin K had no effect on 585-nm pulsed dye laser-induced purpuras, but they found a slightly significant difference (P < .0489) between the mean scores of vitamin K and placebo treated sites in the posttreatment group. As subjective visual analog scale (VAS) was used to evaluate the effect of treatment, we think that the used numerical analysis might be misleading and a ranking-based statistical method ought to have been used to test the validity of the effectiveness of treatment. Additionally, the authors did not demonstrate significant difference between VAS values at any certain days.To evaluate the effects of vitamin K on the prevention and clearing of purpuras, we designed a double-blind, placebo-controlled study on ten healthy individuals (8 female, 2 male, aged: 28-63 years, mean: 35 years). First, capillary resistance (CR) was measured on both forearms using a suction method with Parrot's angiosterrometer.2Gábor M Pathophysiology and Pharmacology of Capillary Resistance. Akadémiai Kiadó, Budapest1974: 16-37Google Scholar, 3Kemény L Csató M Nyirádi J Gábor M Dobozy A Decreased capillary resistance of the uninvolved skin in psoriasis.Acta Derm Venereol (Stockh). 1988; 68: 459-460PubMed Google Scholar, 4Kemény L Csató M Nyirádi J Gábor M Dobozy A Study of dithranol-induced irritation by means of capillary resistance measurements.H+G Zeitschrift für Hautkrankheiten. 1989; 64: 34-40PubMed Google Scholar CR was designated as the minimum suction value (in kPa) at which the first central petechia occurred after application of the suction cup (2 cm in diameter) for 60 seconds. Forearms were then treated twice daily with vitamin K cream or placebo (vehicle only) for one week; then CR was measured again. Vitamin K cream contained 0.5% vitamin K1 (F. Hoffmann-La Roche Ltd., Basel, Switzerland); the vehicle, used as placebo, was an 80% hydrophilic cream, containing 9% glycerine, 4.73% isopropylmyristate, 3% cetylstearyl-alcohol, 0.6% Carbopol 940, 0.315% sodium laurylsulphate, 0.2% soy lecithin, 0.18% sodium hydroxide, metylparabene and propylparabene. Neither vitamin K cream, nor placebo influenced CR, ie, the suction induced petechia formation (Fig 1). To evaluate the effect of vitamin K cream on clearing of established purpuras, petechiae were induced on both forearms of the patients using a standard suction for 60 seconds. Then forearms were treated with vitamin K cream or placebo twice daily. Petechiae were counted at different time intervals after the induction, visually by the same person each time. Counted petechiae were easily distinguishable from each other.2Gábor M Pathophysiology and Pharmacology of Capillary Resistance. Akadémiai Kiadó, Budapest1974: 16-37Google Scholar, 4Kemény L Csató M Nyirádi J Gábor M Dobozy A Study of dithranol-induced irritation by means of capillary resistance measurements.H+G Zeitschrift für Hautkrankheiten. 1989; 64: 34-40PubMed Google Scholar There were no significant differences in the clearing of petechiae between vitamin K or placebo treated sites (Fig 2). Fig 2The number of induced petechiae after application of 40 kPa vacuum on the forearms of the patients. There was a slight but not significant difference in the number of petechiae between the vitamin K and placebo-treated sites on days 1, 2, and 3 (n = 10, p1 = .116; p2 = .072; p3 = .213).View Large Image Figure ViewerDownload (PPT)Our finding that vitamin K cream had no effect on CR correlates well with the finding of Shah et al1Shah N.S Lazarus M.C Bugdodel R Hsia S.L He J Duncan R et al.The effects of topical vitamin K on bruising after laser treatment.J Am Acad Dermatol. 2002; 47: 241-244Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar showing that topical vitamin K was not effective in preventing laser-induced bruising. On the other hand, using an objective method, we could not confirm significant beneficial effect of vitamin K cream on the clearing of petechiae. Contradictory data on the efficacy of vitamin K preparations might be caused by the differences in the concentration and vehicle in the different studies. Therefore, further investigations may be necessary to prove whether vitamin K cream is effective in treating bruising. Bruising occurring after laser treatment is a significant problem in cosmetic dermatology. Although vitamin K creams are widely used for prevention and treatment of purpuras, there is no direct evidence to prove their efficacy. Shah et al1Shah N.S Lazarus M.C Bugdodel R Hsia S.L He J Duncan R et al.The effects of topical vitamin K on bruising after laser treatment.J Am Acad Dermatol. 2002; 47: 241-244Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar found that pretreatment with vitamin K had no effect on 585-nm pulsed dye laser-induced purpuras, but they found a slightly significant difference (P < .0489) between the mean scores of vitamin K and placebo treated sites in the posttreatment group. As subjective visual analog scale (VAS) was used to evaluate the effect of treatment, we think that the used numerical analysis might be misleading and a ranking-based statistical method ought to have been used to test the validity of the effectiveness of treatment. Additionally, the authors did not demonstrate significant difference between VAS values at any certain days. To evaluate the effects of vitamin K on the prevention and clearing of purpuras, we designed a double-blind, placebo-controlled study on ten healthy individuals (8 female, 2 male, aged: 28-63 years, mean: 35 years). First, capillary resistance (CR) was measured on both forearms using a suction method with Parrot's angiosterrometer.2Gábor M Pathophysiology and Pharmacology of Capillary Resistance. Akadémiai Kiadó, Budapest1974: 16-37Google Scholar, 3Kemény L Csató M Nyirádi J Gábor M Dobozy A Decreased capillary resistance of the uninvolved skin in psoriasis.Acta Derm Venereol (Stockh). 1988; 68: 459-460PubMed Google Scholar, 4Kemény L Csató M Nyirádi J Gábor M Dobozy A Study of dithranol-induced irritation by means of capillary resistance measurements.H+G Zeitschrift für Hautkrankheiten. 1989; 64: 34-40PubMed Google Scholar CR was designated as the minimum suction value (in kPa) at which the first central petechia occurred after application of the suction cup (2 cm in diameter) for 60 seconds. Forearms were then treated twice daily with vitamin K cream or placebo (vehicle only) for one week; then CR was measured again. Vitamin K cream contained 0.5% vitamin K1 (F. Hoffmann-La Roche Ltd., Basel, Switzerland); the vehicle, used as placebo, was an 80% hydrophilic cream, containing 9% glycerine, 4.73% isopropylmyristate, 3% cetylstearyl-alcohol, 0.6% Carbopol 940, 0.315% sodium laurylsulphate, 0.2% soy lecithin, 0.18% sodium hydroxide, metylparabene and propylparabene. Neither vitamin K cream, nor placebo influenced CR, ie, the suction induced petechia formation (Fig 1). To evaluate the effect of vitamin K cream on clearing of established purpuras, petechiae were induced on both forearms of the patients using a standard suction for 60 seconds. Then forearms were treated with vitamin K cream or placebo twice daily. Petechiae were counted at different time intervals after the induction, visually by the same person each time. Counted petechiae were easily distinguishable from each other.2Gábor M Pathophysiology and Pharmacology of Capillary Resistance. Akadémiai Kiadó, Budapest1974: 16-37Google Scholar, 4Kemény L Csató M Nyirádi J Gábor M Dobozy A Study of dithranol-induced irritation by means of capillary resistance measurements.H+G Zeitschrift für Hautkrankheiten. 1989; 64: 34-40PubMed Google Scholar There were no significant differences in the clearing of petechiae between vitamin K or placebo treated sites (Fig 2). Our finding that vitamin K cream had no effect on CR correlates well with the finding of Shah et al1Shah N.S Lazarus M.C Bugdodel R Hsia S.L He J Duncan R et al.The effects of topical vitamin K on bruising after laser treatment.J Am Acad Dermatol. 2002; 47: 241-244Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar showing that topical vitamin K was not effective in preventing laser-induced bruising. On the other hand, using an objective method, we could not confirm significant beneficial effect of vitamin K cream on the clearing of petechiae. Contradictory data on the efficacy of vitamin K preparations might be caused by the differences in the concentration and vehicle in the different studies. Therefore, further investigations may be necessary to prove whether vitamin K cream is effective in treating bruising.