Arnica vs. Steroids for Post-Nose Job Bruising and Swelling

Arnica, a perennial from the sunflower family, may be reduce swelling and bruising associated with nose jobs (rhonoplasty)  equally as well as corticosteroids, according to the results of a new study.

Researchers from Case Western Reserve University in Cleveland, Ohio compared both treatments in a group of 48 patients who received rhinoplasty. The patients were randomly divided into three groups. The first group received 10 milligrams of a corticosteroid called dexamethasone during the operation. Patients then received tapered doses of steroid called methyl-prednisone for six days. The second group received arnica for three times a day for four days after the surgery. The third group served as the experimental control and did not receive any medications to reduce bruising and swelling. Three blinded panelists rated the extent of bruising, the intensity of the bruising and the severity of the swelling.

On the second day after surgery, researchers did not notice any significant differences in extent and intensity of bruising among the groups. However, patients in the control group experienced significantly more swelling than patients in the other two groups.

On the eighth day after surgery, the patients who received steroids demonstrated a significantly larger extent of bruising and higher intensity of bruising compared to patients in both the arnica and control groups. On the same day, there were no differences in the amount of swelling among the three groups.

The study authors concluded that both arnica and corticosteroids effectively reduce swelling during the early postoperative period. Arnica does not appear to improve the extent or intensity of bruising after surgery. The delay in resolution of bruising for patients receiving corticosteroids may outweigh the benefit of reducing swelling during the early postoperative period.

Homeopathic and topical arnica is widely used to prevent or treat hemorrhages, hematomas and bruising. Today, arnica is commonly used as a flavoring agent in beverages, frozen dairy desserts, candy, baked goods, gelatins and puddings. In manufacturing, it is used in hair tonics, anti-dandruff preparations, perfumes and other cosmetic agents.

For more information about integrative therapies that have anti-inflammatory properties, please visit Natural Standard’s Comparative Efficacy database.

 

Comments

[James Redley]

I wonder what the implications are for application in sports medicine. I'll see what I can find. Any suggestions in this area?

[Domino]

How do the authors conclude that steroids OR arnica are effective for reducing post-operative swelling in this study??? This study seems pretty poor to me since the control group wasn't a placebo group, and we all know that patients have a tendency to heal faster if they think they are being treated... I'm not convinced by this study.

Regardless - the other day I bumped into a table, and I had heard that homeopathic arnica was good way to prevent bruising, so I put it on (most of my friends laughed at me), and lo and behold it didn't work. I wonder if application of arnica is needed 4x a day or more or less? Is there a certain amount people use? Does it actually prevent the bruise or just reduce its effects? I'm used to applying homeopathic arnica, but did this study use arnica the plant (I thought this was toxic?) or a homeopathic preparation????

[cantabridgian]

So does the minuscule amount of arnica in a homeopathic dilution mean ragweed allergy sufferers could safely use this treatment? I would hate to see seasonal nasal allergies flare up immediately post-nose job. That couldn't be good for anyone's swelling.

[Paul]

I have to admit, in healthcare I've always been a fan of steroids (like prednisone, dexamethasone, or methyl-prenisone) because they have some amazing results with everything from Crohn's disease/ulcerative colitis to asthma and arthritis. The downside is that they have some major health concerns, especially when used long term. Although I'm surprised, I like that this study shows that steroids really don't do a whole lot in this case. In fact, arnica worked even better! It had similar positives without the negatives of the steroids. I would love to see this study expanded to a larger sample size to confirm the results, as well as put in measures for pain relief or other quality of life measurements.

If this does work, as it seems it might, who knows...maybe doctors can tell their patients to go home and eat frozen dairy desserts and baked goods that have arnica in them! Delicious and therapeutic, can it get any better?

[Namaste]

My daughter is concerned about some bruises she got yesterday in a soccer game. She's hoping they go away before a big date next week. Will arnica help to get rid of her bruises too? Could we just create an herbal poultice to put on the bruise? Can she go to the doctor and get an herbal injection for them? Will an herbalist be willing to give her an injection of arnica?

[Stella]

I am not convinced quite yet. There are also studies that show arnica had little benefit in reducing the incidence of postoperative complications. I'd be curious to see the results of further research. Who knows?

[Emily P.]

How was the arnica administered? It's usually used topically, but is that true for this study? I wonder if the method of administration is related to its efficacy?

[Anonymous]

Since there are not any studies that provide strong evidence for its efficacy in reducing swelling and bruising, it is hard to believe if it really works.

Another study that I found concluded that arnica did not prove to be any better than placebo in reducing postoperative complications. The following is the reference for the article:

Stevinson C. Devaraj vs. Fountain-Barber A. Hawkins S. Ernst E. Homeopathic arnica for prevention of pain and bruising: randomized placebo-controlled trial in hand surgery.[see comment]. [Clinical Trial. Journal Article. Randomized Controlled Trial. Research Support, Non-U.S. Gov't] Journal of the Royal Society of Medicine. 96(2):60-5, 2003 Feb.

Regardless of the scientific evidence, sometimes people still follow the 'remedies' that have been passed down from their ancestors. If they THINK it works, then they will still use it regardless if SCIENCE can prove or not!

[Elizabeth]

I know that one of the downsides of having cosmetic surgery, such as rhinoplasty, is the healing process. The area usually looks worse and results are hard to see immediately. I wonder how drastic the difference between the appearance of bruising is using corticosteroids and arnica. Since people's primary concern after surgery is probably looking back to normal as soon as possible, I feel people would be apt to choose the corticosteroids. It is good to know that we can use arnica to treat less severe bruising.

[kdl]

I've got some minor surgery coming up and arnica sounds great, but i'm allergic to a lot of flowers... ragweed and mums and such. Does anybody know if using arnica will give me a rash or hives or anything? what part of the plant is this stuff made of?

[Debbie]

This study is interesting because steroids are a good medication for decreasing inflammation and edema, but there are a lot of adverse effects. One adverse effect associated with steroids is ecchymosis, so it makes sense that the arnica and control groups had less bruising. I also couldn’t determine the difference in edema between the steroid group and arnica group, which I would have liked to know. Were they saying that steroids overall had better edema rating?

[Perfumes]

This is true. There are also studies that show that arnica has little benefit in reducing the incidence of postoperative complications.

http://www.perfumesofparis.net/

[Perfume]

Very informative blog. Kindly please tell me the adverse effects of steroids. I shall be very thankful to you.

http://www.perfumesofparis.net/

[Beck]

I've just read some interesting information on glycerin improving bruising and swelling after skin trauma - this was specific to bruising caused by cosmetic injections like Botox, Juvederm, etc.

The product used in the study is called Bruise Relief (contains glycerin), and the dermatologist conducting the study noted a significant reduction in the severity and duration of bruising with a single post-procedural application of Bruise Relief serum versus a placebo. http://bit.ly/eUZ8f

[esther dreyfuss]

My daughter had a rhinoplasty this week. She's taking cortisone to reduce swelling and bruising. Is it safe to apply arnica on the bruises?

[Maggie S]

As far as side-effects of corticosteroids go, methyprednisone, which was the oral agent used in this study, may cause stomach upset, headache, dizziness, menstrual period changes, trouble sleeping, or weight gain. Long-term use may lead to osteoporosis and suppression of the immune system.

However, topical arnica may cause painful itching and inflamed allergic reactions of the skin, eczema and edematous dermatitis with the formation of pustules. Oral arnica may cause stomach pain, diarrhea, vomiting, and dyspnea, and toxic amounts can cause cardiac arrest and death. So you really have to be careful either way about what you put in your body, and weigh the pros and cons of each therapy versus what is ailing you. It is disappointing that this study did not present any data on the toxicity profiles of either therapy.

[Amanda]

First of all, I do not think it is ethical to not give patients (who served as the control) any medication after rhinoplasty, although the trial mentioned that on day 8, there were no difference of edema between the 3 groups. Based on the study conclusion, arnica may not effectively reduce ecchymosis, and steroids may delay the resolution of ecchymosis. I could not access the full text article of this study, but I was wondering if the study assessed the side effects of steroids (such as muscle weakness, weight gain or osteoporosis) or arnica because this might be a consideration to take into account when choosing them.

To answer Esther’s question: It’s appropriate to apply arnica topically for your daughter, but for oral arnica preparation, I don’t think it’s appropriate because it has drug interactions with the cortisone she’s taking. If your daughter has allergies to certain flowers of the Asteraceae family (for examples: chamomile, chrysanthemum, daily, dandelion, sunflower, May weed, etc.), then you need to watch out for allergic reactions to arnica, such as itchyness or rash. Arnica may reduce the swelling but not the bruising. Oral preparation of arnica is contraindicated if the patient is pregnant.

[Amiya]

Based on this study, by day 8, there was a difference there was significantly more ecchymosis (bleeding/bruising) with the steroid therapy compared to the use of arnica post-rhinoplasty; however, there was no difference in the extent of swelling. If you're looking for a decrease in bruising, then maybe this agent would work better, but in terms of swelling, it may not provide any benefit.

Others studies have shown benefit with arnica use, but the evidence is conflicting since some other studies do not show any benefit. Many of the studies were flawed and did not include safety information, so until more studies are conducted, the clinical application of arnica cannot be determined.

For more information about arnica's use, formulations and safety, take a look at the NS monograph: http://www.naturalstandard.com/monographinfo.asp?title=Arnica&file=arnica

[David hogard]

A bruise is a common skin injury that results in a discoloration of the skin. Blood from damaged blood vessels deep beneath the skin collects near the surface of the skin, resulting in what we think of as a black and blue mark. Symptoms of bruising vary depending on the cause of the bruising. The bruise may be very small and may blend in with the texture of the skin, or it may be large, swollen, and painful.