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    Skin Ulcers (Holistic)

    Skin Ulcers (Holistic)

    About This Condition

    Soothe and heal the sores on your skin for more comfort and fewer infections. According to research or other evidence, the following self-care steps may be helpful.
    • Seek support from C

      Take 1,000 mg of vitamin C every day to speed healing

    • Go for the protein

      Help prevent and heal skin ulcers by eating a diet high in protein and adequate in calories

    • Think zinc

      Under the supervision of a doctor, take at least 50 mg of a zinc supplement, plus 1 to 3 mg of copper, each day to facilitate tissue growth

    • Get a checkup

      Visit your healthcare provider to find out if your skin ulcers are caused by a treatable medical condition

    About

    About This Condition

    Skin ulcers are open sores that are often accompanied by the sloughing-off of inflamed tissue.

    Skin ulcers can be caused by a variety of events, such as trauma, exposure to heat or cold, problems with blood circulation, or irritation from exposure to corrosive material. Pressure ulcers, also known as decubitus ulcers or bedsores, are skin ulcers that develop on areas of the body where the blood supply has been reduced because of prolonged pressure; these may occur in people confined to bed or a chair, or in those who must wear a hard brace or plaster cast. Skin ulcers may become infected, with serious health consequences. Other health conditions that can cause skin ulcers include mouth ulcers ( canker sores ), chronic venous insufficiency , diabetes , infection , and peripheral vascular disease .

    Symptoms

    People with a skin ulcer may have an area of reddened skin. In advanced cases, people may have areas where the skin is open and oozing fluid.

    Holistic Options

    A double-blind trial found systemic hyperbaric oxygen (HBO) treatments, in which the patient is placed in a chamber with highly concentrated oxygen, five days per week for six weeks significantly improved healing of nondiabetic chronic leg ulcers.1 This trial confirms the results from several preliminary studies of systemic HBO therapy.2 , 3 While topical application of HBO (the affected body part is encased in a balloon-like chamber and exposed to concentrated oxygen) for skin ulcers has been reported effective in preliminary trials,4 controlled trials have produced conflicting results.5 , 6 In controlled studies of diabetic patients with skin ulcers or gangrene, systemic HBO has been shown to prevent amputation of affected limbs.7 , 8

    Electrical stimulation applied to the skin is thought to have several biological effects that might accelerate skin ulcer healing.9 A variety of techniques have been investigated, and controlled or double-blind trials have shown positive results for the use of low-voltage galvanic current, high-voltage pulsed current, transcutaneous electrical nerve stimulation (TENS), and pulsed high-frequency electromagnetic therapy.10

    Eating Right

    The right diet is the key to managing many diseases and to improving general quality of life. For this condition, scientific research has found benefit in the following healthy eating tips.

    Recommendation Why
    Go for the protein
    Help prevent and heal skin ulcers by eating a diet high in protein and adequate in calories. Good protein sources include fish, chicken, and soy products.

    Dietary deficiencies may hinder the body?s ability to heal pressure ulcers. A controlled study of 28 malnourished nursing home patients with skin ulcers found that ulcer healing was significantly enhanced by a high-protein diet (24% protein) compared with a lower protein (14%) diet.11 A controlled study of critically ill older patients found that increasing calorie and protein intake with dietary supplements for 15 days reduced the risk of developing a skin ulcer.12

    Supplements

    What Are Star Ratings?

    Our proprietary ?Star-Rating? system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by some in the medical community, and whether studies have found them to be effective for other people.

    For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.

    3 Stars Reliable and relatively consistent scientific data showing a substantial health benefit.

    2 Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

    1 Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

    Supplement Why
    2 Stars
    Aloe
    Apply gel on gauze or dressings daily
    Learn More

    Aloe vera has been used historically to improve wound healing and contains several constituents that may be important for this effect. A group of three patients who had chronic skin ulcerations for 5, 7, and 15 years, respectively, had a rapid reduction in ulcer size after the application of aloe gel on gauze bandages to the ulcers, according to a preliminary report.13 A controlled study found most patients with pressure ulcers had complete healing after applying an aloe hydrogel dressing to the ulcers every day for ten weeks.14 However, this result was not significantly better than that achieved with a moist saline gauze dressing. The amorphous hydrogel dressing used in the above study and derived from the aloe plant (Carrasyn Gel Wound Dressing, Carrington Laboratories, Irving, TX) is approved by the U.S. Food and Drug Administration for the management of mild to moderate skin ulcers.

    2 Stars
    Diosmin and Hesperidin
    900 mg per day of diosmin and 100 mg per day of hesperidin
    Learn More

    A double-blind trial found that a combination of 900 mg per day of diosmin and 100 mg per day of hesperidin, two members of the flavonoid family, resulted in significantly greater healing of venous leg ulcers after two months.15 , 16 Related flavonoids known as hydroxyethylrutosides have also been investigated for venous ulcer healing. While one controlled study reported significant additional benefit when 2,000 mg per day of hydroxyethylrutosides were added to compression stocking therapy,17 another double-blind trial using 1,000 mg per day found no effect on ulcer healing;18 a second double-blind trial found no effect of 1,000 mg per day hydroxyethylrutosides on the prevention of venous ulcer recurrences.19

    2 Stars
    Essential Fatty Acids Topical
    Refer to label instructions
    Learn More

    Pressure ulcers and diabetic ulcers frequently develop in malnourished and/or institutionalized people. A double-blind study20 of malnourished people compared topical application of 20 ml of a solution containing essential fatty acids (EFAs) and linoleic acid extracted from sunflower oil with a control solution containing topical mineral oil. Each solution was applied to the skin three times per day. Compared with the control solution, the solution containing EFAs significantly reduced the incidence of pressure ulcers and improved the hydration and elasticity of the skin.

    2 Stars
    Evening Primrose Oil
    1,500 mg with each meal
    Learn More

    A preliminary report suggested that evening primrose oil improves blood flow to the legs and heals or reduces the size of venous leg ulcers.21 No controlled research has further investigated this claim.

    2 Stars
    Folic Acid
    Consult a qualified healthcare practitioner
    Learn More

    An older preliminary report suggested that large amounts of folic acid given both orally and by injection could promote healing of chronic skin ulcers due to poor circulation.22 No controlled research has further investigated this claim.

    2 Stars
    Gotu Kola
    Apply an ointment or powder containing 1 to 2% herbal extract daily
    Learn More

    Gotu kola (Centella asiatica) extracts are sometimes used topically to help speed wound healing. Test tube studies have found that extracts of gotu kola high in the active triterpene constituents asiaticosides, madecassoides, asiatic acids, and madecassic acids increase collagen synthesis.23 , 24 An animal study found that topical application of asiaticoside isolated from gotu kola, used in a 0.2% solution, improved healing in nonulcer skin wounds.25 An overview of three small human clinical trials suggests that topical use of an ointment or powder containing a gotu kola extract high in the active triterpene compounds may speed wound healing in people with slow-healing skin ulcers.26 These studies used either a topical ointment with a 1% extract concentration or a powder with a 2% extract concentration. People in these studies were typically treated with intramuscular injections of either isolated asiaticosides or the mixed triterpenes three times per week while using the topical ointment or powder.

    2 Stars
    Hyaluronic Acid
    Apply a gel containing a partial benzyl ester derivative of hyaluronan under compression bandaging daily
    Learn More

    A controlled trial found that topical application of a hyaluronic acid compound with compression bandaging was significantly better than bandaging alone for healing chronic venous skin ulcers.27No research has investigated whether oral hyaluronic acid supplements might be similarly effective.

    2 Stars
    Pycnogenol
    150 mg per day orally, along with topical application of 100 mg daily
    Learn More
    In a controlled study, diabetic skin ulcers were treated with standard medications plus either 150 mg per day of Pycnogenol orally, 100 mg Pycnogenol topically applied to the ulcers daily, or a combination of oral and topical Pycnogenol treatment.33 All treatments produced complete healing in more subjects after six weeks compared with a control group receiving no Pycnogenol treatment, but the group receiving oral and topical Pycnogenol had the greatest reductions in ulcer size and in pain and other associated symptoms. In a small controlled study of venous skin ulcers, the same combination of oral and topical Pycnogenol was more effective for healing than oral Pycnogenol treatment alone.34
    2 Stars
    Vitamin C
    1,000 mg daily
    Learn More

    Antioxidants such as vitamin C , vitamin E , and glutathione are depleted in healing skin tissue.35 One animal study found that vitamin E (alpha-tocopherol) applied to the skin shortened the healing time of skin ulcers.36 Another animal study reported that administration of oral vitamin E before skin lesions were introduced into the skin prevented some of the tissue damage associated with the development of pressure ulcers.37 A controlled human trial found that 400 IU of vitamin E daily improved the results of skin graft surgery for chronic venous ulcers.38 No further research has investigated the potential benefit of vitamin E for skin ulcers.

    Animal research has suggested that vitamin C may help prevent skin ulcers,39 and in a preliminary study,40 elderly patients with pressure ulcers had lower blood levels of vitamin C than did ulcer-free patients. Supplementation with vitamin C (3 grams per day) increased the speed of healing of leg ulcers in patients with a blood disorder called thalassemia , according to a double-blind study.41 And while a double-blind trial of surgical patients with pressure ulcers found that supplementation with 500 mg of vitamin C twice a day accelerated ulcer healing,42 a similar double-blind trial found no difference in the effectiveness of either 20 mg per day or 1,000 mg per day of vitamin C.43

    2 Stars
    Vitamin E Oral
    400 IU daily
    Learn More

    Antioxidants such as vitamin C , vitamin E , and glutathione are depleted in healing skin tissue.44 One animal study found that vitamin E (alpha-tocopherol) applied to the skin shortened the healing time of skin ulcers.45 Another animal study reported that administration of oral vitamin E before skin lesions were introduced into the skin prevented some of the tissue damage associated with the development of pressure ulcers.46 A controlled human trial found that 400 IU of vitamin E daily improved the results of skin graft surgery for chronic venous ulcers.47 No further research has investigated the potential benefit of vitamin E for skin ulcers.

    2 Stars
    Zinc
    Take under medical supervision: 50 mg of zinc (plus 1 to 3 mg of copper daily, to prevent depletion) and apply zinc-containing bandages or tape to the area
    Learn More

    Zinc plays an important role in tissue growth processes important for skin ulcer healing. One study reported that patients with pressure ulcers had lower blood levels of zinc and iron than did patients without pressure ulcers,48 and preliminary reports suggested zinc supplements could help some types of skin ulcer.49 Supplementation with 150 mg of zinc per day improved healing in a preliminary study of elderly patients suffering from chronic leg ulcers.50 Double-blind trials using 135 to 150 mg of zinc daily have shown improvement51 only in patients with low blood zinc levels,52 and no improvement in leg ulcer healing.53 , 54 A double-blind trial of 150 mg zinc per day in people with skin ulcers due to sickle cell anemia found that the healing rate was almost three times faster in the zinc group than in the placebo group after six months.55 Lastly, a preliminary study of patients with skin ulcers due to leprosy found that 50 mg of zinc per day in addition to anti-leprosy medication resulted in complete healing in most patients within 6 to 12 weeks.56 Long-term zinc supplementation at these levels should be accompanied by supplements of copper and perhaps calcium, iron, and magnesium. Large amounts of zinc (over 50 mg per day) should only be taken under the supervision of a doctor.

    Topically applied zinc using zinc-containing bandages has improved healing of leg ulcers in double-blind studies of both zinc-deficient57 and elderly individuals.58 Most controlled comparison studies have reported that these bandages are no more effective than other bandages used in the conventional treatment of skin ulcers,59 , 60 but one controlled trial found non-elastic zinc bandages superior to alginate dressings or zinc-containing elastic stockinettes.61 Two controlled trials of zinc-containing tape for foot ulcers due to leprosy concluded that zinc tape was similarly effective, but more convenient than conventional dressings.62 , 63

    1 Star
    Comfrey Topical
    Refer to label instructions
    Learn More
    Comfrey has a long history of use as a topical agent for treating wounds, skin ulcers, thrombophlebitis, bruises, and sprains and strains.64 , 65
    1 Star
    Vitamin E Topical
    Refer to label instructions
    Learn More

    Antioxidants such as vitamin C , vitamin E , and glutathione are depleted in healing skin tissue.66 One animal study found that vitamin E (alpha-tocopherol) applied to the skin shortened the healing time of skin ulcers.67 Another animal study reported that administration of oral vitamin E before skin lesions were introduced into the skin prevented some of the tissue damage associated with the development of pressure ulcers.68 A controlled human trial found that 400 IU of vitamin E daily improved the results of skin graft surgery for chronic venous ulcers.69 No further research has investigated the potential benefit of vitamin E for skin ulcers.

    References

    1. Hammarlund C, Sundberg T. Hyperbaric oxygen reduced size of chronic leg ulcers: a randomized double-blind study. Plast Reconstr Surg 1994;93:829?34.

    2. Wattel F, Mathieu D, Coget JM, Billard V. Hyperbaric oxygen therapy in chronic vascular wound management. Angiology 1990;41:59?65.

    3. Lee HC, Niu KC, Chen SH, et al. Hyperbaric oxygen therapy in clinical application. A report of a 12-year experience. Chung Hua I Hsueh Tsa Chih (Taipei) 1989;43:307?16.

    4. Landau Z. Topical hyperbaric oxygen and low energy laser for the treatment of diabetic foot ulcers. Arch Orthop Trauma Surg 1998;117:156?8.

    5. Heng MC, Pilgrim JP, Beck FW. A simplified hyperbaric oxygen technique for leg ulcers. Arch Dermatol 1984;120:640?5.

    6. Leslie CA, Sapico FL, Ginunas VJ, Adkins RH. Randomized controlled trial of topical hyperbaric oxygen for treatment of diabetic foot ulcers. Diabetes Care 1988;11:111?5.

    7. Faglia E, Favales F, Aldeghi A, et al. Adjunctive systemic hyperbaric oxygen therapy in treatment of severe prevalently ischemic diabetic foot ulcer. A randomized study. Diabetes Care 1996;19:1338?43.

    8. Baroni G, Porro T, Faglia E, et al. Hyperbaric oxygen in diabetic gangrene treatment. Diabetes Care 1987;10:81?6.

    9. Frantz RA. Adjuvant therapy for ulcer care. Clin Geriatr Med 1997;13:553?64 [review].

    10. Frantz RA. Adjuvant therapy for ulcer care. Clin Geriatr Med 1997;13:553?64 [review].

    11. Breslow RA, Hallfrisch J, Guy DG, et al. The importance of dietary protein in healing pressure ulcers. J Am Geratr Soc 1993;41:357?62.

    12. Bourdel-Marchasson I, Barateau M, Rondeau V, et al. A multi-center trial of oral nutritional supplementation in critically ill older inpatients. Nutrition 2000;16:1?5.

    13. Zawahry ME, Hegazy MR, Helal M. Use of aloe in treating leg ulcers and dermatoses. Int J Dermatol 1973;12:68?73.

    14. Thomas DR, Goode PS, LaMaster K, Tennyson T. Acemannan hydrogel dressing versus saline dressing for pressure ulcers. A randomized, controlled trial. Adv WoundCare 1998;11:273?6.

    15. Guilhou JJ, Fevrier F, Debure C, et al. Benefit of a 2-month treatment with a micronized, purified flavinoidic fraction on venous ulcer healing. A randomized, double-blind, controlled versus placebo trial. Int J Micro Clin Exp 1997;17:21?6.

    16. Guilhou JJ, Dereure O, Marzin L, et al. Efficacy of Daflon 500 mg in venous leg ulcer healing: a double-blind, randomized, controlled versus placebo trial in 107 patients. Angiology 1997;48:77?85.

    17. Stegmann W, Hubner K, Deichmann B, Muller B. Efficacy of O-(s-hydroxyethyl)-rutosides in the treatment of venous leg ulcers. Phlebologie 1987;40:149?56 [in French].

    18. Mann RJ. A double blind trial of oral O. B-hydroxyethyl rutosides for stasis leg ulcers. Br J Clin Pract 1981;35:79?81.

    19. Wright DD, Franks PJ, Blair SD, et al. Oxerutins in the prevention of recurrence in chronic venous ulceration: randomized controlled trial. Br J Surg 1991;78:1269?70.

    20. Declair V. Usefulness of topical application of essential fatty acids to prevent pressure ulcers. Ostomy Wound Management 1997;43:48?52.

    21. Simpson LO, Hand BI, Olds RJ. Large leg ulcers, Efamol and hyperbaric oxygen. N Z Med J 1986;99:552 [abstract].

    22. Kopjas TL. Effect of folic acid on collateral circulation in diffuse chronic arteriosclerosis. J Am Geriatr Soc 1966;14:1187?92.

    23. Marquart FX, Bellon G, Gillery P, et al. Stimulation of collagen synthesis in fibroblast cultures by a triterpene extracted from Centella asiatica. Connective Tissue Res 1990;24:107?20.

    24. Tenni R, Zanaboni G, De Agostini MP, et al. Effect of the triterpenoid fraction of Centella asiatica on macromolecules of the connective matrix in human skin fibroblast cultures. Ital J Biochem 1988;37:69?77.

    25. Shukla A, Rasik AM, Jain GK, et al. In vitro and in vivo wound healing of asiaticoside isolated from Centella asiatica. JEthnopharmacol 1999;65:1?11.

    26. Brinkhaus B, Linder M, Schuppan D, Hahn EG. Chemical, pharmacological and clinical profile of the East Asian medicinal plant Centella asiatica. Phytomedicine 2000;7:427?48.

    27. Taddeucci P, Pianigiani E, Colletta V, et al. An evaluation of Hyalofill-F plus compression bandaging in the treatment of chronic venous ulcers. J Wound Care 2004;13:202-4.

    28. Stegmann W, Hubner K, Deichmann B, Muller B. Efficacy of O-(s-hydroxyethyl)-rutosides in the treatment of venous leg ulcers. Phlebologie 1987;40:149?56 [in French].

    29. Mann RJ. A double blind trial of oral O. B-hydroxyethyl rutosides for stasis leg ulcers. Br J Clin Pract 1981;35:79?81.

    30. Wright DD, Franks PJ, Blair SD, et al. Oxerutins in the prevention of recurrence in chronic venous ulceration: randomized controlled trial. Br J Surg 1991;78:1269?70.

    31. Guilhou JJ, Fevrier F, Debure C, et al. Benefit of a 2-month treatment with a micronized, purified flavinoidic fraction on venous ulcer healing. A randomized, double-blind, controlled versus placebo trial. Int J Micro Clin Exp 1997;17:21?6.

    32. Guilhou JJ, Dereure O, Marzin L, et al. Efficacy of Daflon 500 mg in venous leg ulcer healing: a double-blind, randomized, controlled versus placebo trial in 107 patients. Angiology 1997;48:77?85.

    33. Belcaro G, Cesarone MR, Errichi BM, et al. Diabetic ulcers: microcirculatory improvement and faster healing with pycnogenol. Clin Appl Thromb Hemost 2006;12:318-23.

    34. Belcaro G, Cesarone MR, Errichi BM, et al. Venous ulcers: microcirculatory improvement and faster healing with local use of Pycnogenol. Angiology 2005;56:699-705.

    35. Houwing R, Overgoor M, Kon M, et al. Pressure-induced skin lesions in pigs: reperfusion injury and the effects of vitamin E. J WoundCare 2000; 9:36?40.

    36. Lucero MJ, Vigo J, Rabasco AM, et al. Protection by alpha-tocopherol against skin necrosis induced by doxorubicin hydrochloride. Pharmazie 1993;48:772?5.

    37. Shukla A, Rasik AM, Patnaik GK. Depletion of reduced glutathione, ascorbic acid, vitamin E, and antioxidant defence enzymes in a healing cutaneous wound. Free RadicRes 1997;26:93?101.

    38. Ramasastry, SS, Angel MF, Narayanan K, et al. Biochemical evidence of lipoperoxidation in venous stasis ulcer: Beneficial role of vitamin E as antioxidant. Ann NY Acad Sci 1989; 506?8.

    39. Hajarizadeh H, Lebredo L, Barrie R, Woltering EA. Protective effect of doxorubicin in vitamin C or dimethyl sulfoxide against skin ulceration in the pig. Ann Surg Oncol 1994;1:411?4.

    40. Goode HF, Burns E, Walker BE. Vitamin C depletion and pressure sores in elderly patients with femoral neck fracture. BMJ 1992;305:935?7.

    41. Afifi AM, Ellis L, Huntsman RG, Said MI. High dose ascorbic acid in the management of thalassaemia leg ulcers?a pilot study. Br J Dermatol 1975;92:339?41.

    42. Taylor TV, Rimmer S, Day B, et al. Ascorbic acid supplementation in the treatment of pressure cores. Lancet 1974;ii:544?6.

    43. ter Riet G, Kessels AG, Knipschild PG. Randomized clinical trial of ascorbic acid in the treatment of pressure ulcers. J Clin Epidemiol 1995;48:1453?60.

    44. Houwing R, Overgoor M, Kon M, et al. Pressure-induced skin lesions in pigs: reperfusion injury and the effects of vitamin E. J WoundCare 2000; 9:36?40.

    45. Lucero MJ, Vigo J, Rabasco AM, et al. Protection by alpha-tocopherol against skin necrosis induced by doxorubicin hydrochloride. Pharmazie 1993;48:772?5.

    46. Shukla A, Rasik AM, Patnaik GK. Depletion of reduced glutathione, ascorbic acid, vitamin E, and antioxidant defence enzymes in a healing cutaneous wound. Free RadicRes 1997;26:93?101.

    47. Ramasastry, SS, Angel MF, Narayanan K, et al. Biochemical evidence of lipoperoxidation in venous stasis ulcer: Beneficial role of vitamin E as antioxidant. Ann NY Acad Sci 1989; 506?8.

    48. Williams CM, Lines CM, McKay EC. Iron and zinc status in multiple sclerosis patients with pressure sores. Eur J Clin Nutr 1988;42:321?8.

    49. Greaves MW, Skillen AW. Effects of long-continued ingestion of zinc sulphate in patients with venous leg ulceration. Lancet 1970;2:889?91.

    50. Carruthers R. Oral zinc sulphate in leg ulcers. Lancet 1969;1:1264.

    51. Haeger K, Lanner E, Magnusson PO. Oral zinc sulfate in the treatment of venous leg ulcers. In: Pories WJ, Strain WH, Hwu JM, et al (eds), Clinical applications of zinc metabolism. Springfield, IL: CC Thomas, 1974, 158?67.

    52. Hallbook T, Lanner E. Serum-zinc and healing of venous leg ulcers. Lancet 1972;2:780?2.

    53. Greaves MW, Ive FA. Double-blind trial of zinc sulphate in the treatment of chronic venous leg ulceration. Br J Dermatol 1972;87:632?4.

    54. Clayton RJ. Double-blind trial of oral zinc sulphate in patients with leg ulcers. Br J Clin Pract 1972;26:368?70.

    55. Serjeant GR, Galloway RE, Gueri MC. Oral zinc sulphate in sickle-cell ulcers. Lancet 1970;2:891?3.

    56. Mathur NK, Bumb RA. Oral zinc in the trophic ulcers of leprosy. Int J Lepr 1983;51:410?1.

    57. Agren MS. Studies on zinc in wound healing. Acta Derm Venerol Suppl 1990;154:1?36.

    58. Stromberg HE, Agren MS. Topical zinc oxide treatment improves arterial and venous leg ulcers. Br J Dermatol 1984;111:461?8.

    59. Eriksson G. Comparison of two occlusive bandages in the treatment of venous leg ulcers. Br J Dermatol 1986;114:227?30.

    60. Agren MS, Stromberg HE. Topical treatment of pressure ulcers. A randomized comparative trial of Varidase and zinc oxide. Scand J Plast Reconstr Surg 1985;19:97?100.

    61. Stacey MC, Jopp-Mckay AG, Rashid P, et al. The influence of dressings on venous ulcer healing?a randomised trial. Eur J Vasc Endovasc Surg 1997;13:174?9.

    62. Soderberg T, Hallmans G, Stenstrom S, et al. Treatment of leprosy wounds with adhesive zinc tape. Lepr Rev 1982;53:271?6.

    63. Walton RT, Fritschi EP, Umapathy VA. Treatment of plantar ulcers in leprosy patients in the community with adhesive zinc tape. Lepr Rev 1986;57:53?6.

    64. Mills SY. Out of the Earth: The Essential Book of Herbal Medicine. New York: Viking Arkana, 1991, 544?7.

    65. Weiss RF. Herbal Medicine. Gothenburg, Sweden: Ab Arcanum and Beaconsfield, UK: Beaconsfield Publishers Ltd., 1988, 334?5.

    66. Houwing R, Overgoor M, Kon M, et al. Pressure-induced skin lesions in pigs: reperfusion injury and the effects of vitamin E. J WoundCare 2000; 9:36?40.

    67. Lucero MJ, Vigo J, Rabasco AM, et al. Protection by alpha-tocopherol against skin necrosis induced by doxorubicin hydrochloride. Pharmazie 1993;48:772?5.

    68. Shukla A, Rasik AM, Patnaik GK. Depletion of reduced glutathione, ascorbic acid, vitamin E, and antioxidant defence enzymes in a healing cutaneous wound. Free RadicRes 1997;26:93?101.

    69. Ramasastry, SS, Angel MF, Narayanan K, et al. Biochemical evidence of lipoperoxidation in venous stasis ulcer: Beneficial role of vitamin E as antioxidant. Ann NY Acad Sci 1989; 506?8.

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