Hypertrophic Scars: Are Vitamins and Inflammatory Biomarkers Related with the Pathophysiology of Wound Healing?

BACKGROUND

Hypertrophic scars are a consequence of wound healing.

OBJECTIVE

The objective of the present study is to evaluate vitamin D and inflammatory biomarker plasma levels during wound healing.

METHODS

A prospective study was performed in patients (n = 63) submitted to body contouring surgery. Blood samples were collected before (t ) and 5 days after surgery (t ). Blood cell count, protein inflammatory biomarkers, and circulating plasma levels of 25(OH)D, vitamin A and vitamin E were quantified. Six months after surgery, scars were evaluated and classified as normal or hypertrophic.

RESULTS

At the end of the study, 73% of the patients developed a normal scar (control group, n = 46) and 27% of the patients presented hypertrophic scars (HT group, n = 17). The patients in the HT group presented higher eosinophil (0.145 × 10 /L vs. 0.104 × 10 /L, p = 0.028) and basophil count (0.031 × 10 /L vs. 0.22 × 10 /L, p = 0.049) and C-reactive protein levels (6.12 mg/L vs. 2.30 mg/L, p = 0.015) in t than the patients in the control group. At t , the patients in the HT group showed a decrease in neutrophil (3.144 × 10 vs. 4.03 × 10/L, p = 0.031) and an increase in basophil (0.024 × 10/L vs. 0.015 × 10/L, p = 0.005) and lymphocyte count (1.836 × 10 /L vs. 1.557 × 10/L; p = 0.028). Before surgery, vitamin D plasma levels were found to be decreased by almost 50% (23.52 ng/mL vs. 15.46 ng/mL, p = 0.031) in the patients who developed hypertrophic scars. Thirty-one percent of the patients submitted to bariatric surgery had more hypertrophic scars, versus 24% of the patients with no previous bariatric surgery.

CONCLUSION

There is a different systemic inflammatory profile response in the patients during the formation of hypertrophic scars. Vitamin D plasma levels are marked reduced in these patients. Considering the powerful anti-inflammatory effect of vitamin D, these findings could be related.