Vitamin E gel reduces time of healing of digital ulcers in systemic sclerosis

Clin Exp Rheumatol. 2009 May-Jun;27(3 Suppl 54):51-4.


Background: In systemic sclerosis (SSc), digital ulcers (DU) are painful, difficult to heal and frequently infected, thus greatly affecting quality of life and increasing SSc-related disability. Vitamin E has been previously used in cutaneous lesions for its antioxidant and anti-inflammatory effects.

Objectives: To study the healing effect of D-alpha-tocopheryl acetate (acetic ester of alpha-tocopherol) (VE) gel on DU of SSc patients.

Methods: 27 SSc patients with a total of 86 DU were enrolled in an open pilot study. The patients were randomly assigned to two groups: 15 patients were treated until DU healing with the local standard ulcer care protocol with the application of vitamin E gel (experimental group), while 12 patients were treated with standard ulcer care protocol only (control group). In both groups, DU were treated twice a week and pain was scored by a NRS (numeric rating scale). In both groups the cost of medications was analysed.

Results: VE induced a faster healing of DU in respect to controls (13.22+/-2.72 weeks, versus 20.94+/-3.65; p<0.0001) with a lower number of medications (26.18+/-5.63 vs. 41.88+/-7.31; p<0.0001). Resolution of pain was faster in experimental (17.82+/-4,59 medications) than in controls (26.26+/-19.16 medications) (p=0.0022). In the experimental group, the cost of medications was significantly lower (6,919.15 euros/patient) than in the control group (11,056.32 euros/patient).

Conclusion: The application of VE reduces time of healing and has a faster resolution of pain, with a significant reduction of costs. Topical VE may improve the management of DU in SSc.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Administration, Topical
  • Antioxidants / administration & dosage
  • Antioxidants / therapeutic use*
  • Female
  • Fingers
  • Gels
  • Humans
  • Male
  • Middle Aged
  • Pain / drug therapy
  • Pain / etiology
  • Pain / physiopathology
  • Pilot Projects
  • Scleroderma, Systemic / complications
  • Scleroderma, Systemic / drug therapy*
  • Scleroderma, Systemic / physiopathology
  • Severity of Illness Index
  • Skin / drug effects
  • Skin / pathology
  • Skin Ulcer / drug therapy*
  • Skin Ulcer / etiology
  • Skin Ulcer / physiopathology
  • Vitamin E / administration & dosage
  • Vitamin E / therapeutic use*


  • Antioxidants
  • Gels
  • Vitamin E