Arnica is a well known and recognized homeopathic supplement in plastic surgery. It is touted as an anti-bruise and anti-inflammatory treatment measure that is widely prescribed after many procedures from injectable fillers to facelifts. While it is widely used, the interesting question is whether it is really effective and what is the evidence that it works.
Arnica is an orange-yellow flower that has its origin from Europe where it once grew over large areas. It is a genus with dozens of perennial herbaceous species belonging to the sunflower family Asteraceae. Several species within this genus contain helenalin (e.g., Arnica Montana) which is found in the leaves and stems of the flower. This is the agent that is believed to be responsible for any anti-inflammatory benefits.
Historically there are few studies that have shown that Arnica was more effective than a placebo for any of its touted benefits. More recent animal studies have shown increased levels of anti-inflammatory cytokine interleukin (IL-10) and decreased levels of pro-inflammatory protein tumor necrosis factor. (TNF) Both effects can have clinical effects of reduced swelling and inflammation. A clinical study of carpal tunnel surgery showed less pain at two weeks when oral and topical Arnica was used. In a clinical study of big toe surgery, Arnica was found to be equally effective at reducing wound irritation (less effective at pain reduction) but less costly and better tolerated than Diclofenac. A clinical study to evaluate bruising in facelift surgery did show a significant lessening of the amount of bruising with Arnica Montana.
The clinical evidence that Arnica has a significant anti-inflammatory effect is not strong. There is only one clinical study that shows it has an anti-bruising. (despite the fact that it continues to be highly touted as such) There are a surprisingly limited number of studies in the plastic surgery literature that have been done let alone show it has beneficial recovery effects. But Arnica continues to be used in plastic surgery largely because there is no harm in doing so and it is very inexpensive. There is likely something to the homeopathic effect of a ‘natural remedy’ that also propagates its continued use.
One of the problems with the use of Arnica is that its preparations have wide variability. Unlike a prescription drug, how Arnica tablets and creams are prepared is without significant manufacturing standards. Then there is the X and C potency or dose letter attached with a number. This adds to the confusion. An X preparation (decimal system) is, for example, where one part of the medicinal substance is mixed with nine parts of the vehicle. (1+ 9 = 10) In this system the X always follows the number. In a C preparation (Centesimal system), one part of the medicinal substance is mixed with ninety parts of the vehicle. Like the X system, the C always follows the number. It can be seen, therefore, that 10X and 10C Arnica preparations for example are not comparable in potency. The purpose of the letters X and C is to indicate how they are prepared and as no indication as to its potential effectiveness like typical milligram dosages of drugs are.
Because of the wide variability in how Arnica is prepared and the difficulty in studying the clinical effects of swelling, pain and bruising, demonstrating that Arnica actually has any positive benefits on surgical recovery is difficult. Its continued use will be based on limited clinical information of its effectiveness and more on whatever placebo effects it may provide.
Dr. Barry Eppley
Indianapolis, Indiana