Unfortunately, the science behind the usage of vitamin E with wound healing and scar improvement is not favorable.
The most important way to improve or prevent scars is wound management. How you tend to a wound is very important to the final appearance of the skin after healing.
DON’T Air It Out
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. A dried, thick scab is not favorable. Thin scabbing is okay if you are using an emollient. So, keep it greasy!
DO Cover It Up
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. It’s also recommended that you cover a wound with “Vaseline and a Band-aid” if you tend to be a picker. Picking a scab worsens scarring and sets back the healing process.
If a wound is at risk for infection (like a skinned knee), apply 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, gently massage with a moisturizer or petrolatum to 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 a 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, which is why it’s recommended that you only use a topical antibiotic for 3 to 5 days before switching to petrolatum.
CLEAN a Wound
To clean a shallow wound, many people use hydrogen peroxide every day while the skin heals. Unfortunately, recent studies have shown that continued usage of peroxide actually slows healing and the migration of skin cells. All you need to do to clean a shallow wound is rinse with lots of water to get rid of dirt and bacteria. Peroxide can be used initially after completely rinsing the wound but may cause pain. It is not recommended to use peroxide again after the initial cleaning. Shallow wounds can be cleaned daily with soap and water—and gently! There is no need to scrub wounds that are still healing. After gentle cleansing, the wound can be patted dry before applying a topical antibiotic or petrolatum. If a wound is deep, it should be seen by a physician immediately.
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 than silicone gel sheeting alone. This is the only time topical vitamin E can be effective in preventing scarring—when it is used in conjunction with silicone gel sheeting on a thick, hypertrophic scar.