Question: I frequently injure my skin due to my work. I get scars when the skin heals. A friend told me that vitamin E capsules could be opened and applied to my scars to lessen the thickening and redness. Is this true and do you recommend it?
Answer: Vitamin E has many anecdotal reports with regard to wound healing. Many people swear by it and it seems everyone has heard a story about vitamin E helping scarring and wound healing. The science behind the usage of vitamin E with wound healing and scar improvement is not favorable. Multiple studies have compared using emollients (like petrolatum, e.g. Vaseline) to emollients with added vitamin E to see if the vitamin E group would have better healing and scar appearance after skin surgery. No study has shown any difference between a “base” emollient/cream applied to a scar versus a vitamin E cream/emollient with regard to healing or improved scar. Furthermore, vitamin E applied topically can cause a skin reaction called dermatitis in about 20% of people. Typically, I do not routinely recommend vitamin E creams or vitamin E applied to the skin for wound healing or scar improvement.
The most important way to improve scars is to prevent them in the first place. Wound management is very important to the final appearance of the skin after healing:
1) The old adage of letting a wound dry out in the air to “let it breathe” is not correct. A topical emollient like Vaseline (petrolatum) should be applied to non-infected wounds to prevent the skin from drying out. The epidermis heals itself and covers wounds by skin cells migrating across a wound. The migration of the skin cells is very important to the normal healing process. Allowing a wound to dry out slows healing and can lead to worse scarring. I never like to see a dried, thick scab. Thin scabbing is okay if you are using an emollient. So, “Keep it Greasy.”
2) Covering a wound is important only if the location of the wound is prone to getting dirty or dusty, is in an area where clothes rub against it, is draining clear (“serous”) fluid, or is located where a bandage improves the appearance during healing. I also often recommend covering a wound with “Vaseline and a Band-aid” in my patients who tend to be “pickers.” Picking a scab worsens scarring and sets back the healing process.
3) If a wound is at risk for infection (like a skinned knee), I recommend applying a topical antibiotic after the wound has been cleaned. The topical antibiotic, which is usually in a petrolatum “base”, should be applied frequently to keep the wound “greasy” for 3 to 5 days and then switched to a plain petrolatum (Vaseline) to keep the wound greasy until healing is complete. After the skin heals, gentle massage with a moisturizer or petrolatum can help minimize and remove the thickening that often occurs with wound healing. Of course, if a wound becomes infected or appears redder, develops pus, feels warm to the touch, or becomes very painful, it should be seen by your physician immediately. It is important to note that topical antibiotics like Neosporin (triple-antibiotic ointment), bacitracin, and neomycin can cause skin reactions with prolonged usage–that is why I recommend only 3 to 5 days of a topical antibiotic before switching to petrolatum.
4) To clean a shallow wound, many people use peroxide every day while the skin heals. I do not encourage daily peroxide usage. Recent studies have shown that continued usage of peroxide actually slows healing and the migration of skin cells. Typically, I recommend cleaning a shallow wound initially with lots of water to rinse out dirt and bacteria. Peroxide can be used initially after completely rinsing the wound but may cause pain. I don’t recommend using peroxide again after the initial cleaning. Shallow wounds can be cleaned daily with soap and water—gently!! There is no need to scrub wounds that are healing. After gentle cleansing, the wound can be patted dry before applying a topical antibiotic or petrolatum. “Keep it Greasy!” If a wound is deep, it should be seen by a physician immediately.
5) For a thick, “hypertrophic” scar or keloid, one of the most effective treatments to minimizing the thickening is the use of silicone gel sheeting. These are sold over the counter. It is important to note that silicone gel sheeting should not be used until a wound has healed completely. Interestingly, the combination of a topical vitamin E with the usage of silicone gel sheeting has been shown to provide even more improvement over just silicone gel sheeting for thickened, “hypertrophic” scars. It is the one time I will recommend topical vitamin E for a scar—when it is used in conjunction with silicone gel sheeting on a thick, “hypertrophic” scar.