Ever wonder why some cuts result in scars and some don’t? Or why some scrapes heal well and some don’t? One of the most important factors is the depth of injury to the skin. The skin is made up of three layers: Epidermis, Dermis and the Subcutaneous layer. If your skin is injured to the depth of the dermis or below you WILL get a scar. But how well the scar heals and ultimately looks depends largely on how you take care of it during the healing process.
So you just fell and scraped your knee. Now what?
First clean it! The best option is cool water and antibacterial soap. My favorite is Hibiclens, available at all drug stores. This will kill 99.9% of the organisms that could cause you trouble. It is also what most dermatologists use to clean the skin prior to procedures in the office.
Second, you need to keep wound moist and protected to promote healing. We’ve all been told to let our wounds ‘air out’ and form a scab. This advice is dead wrong. Data shows with certainty that injured skin that is kept covered with an occlusive ointment and a bandage heals significantly faster than when left uncovered. Creating a moist environment maintains high water levels in the skin, key for healing.
What to use as an ointment? This is more complicated than you would expect.
DO NOT use over-the-counter antibiotic ointments such as Neosporin or Polysporin. These products contain neomycin and bacitracin; ingredients that are "Top-10 Sensitizers.” Meaning they are some of the most likely ingredients to cause an allergic reaction in the skin according to the North American Contact Dermatitis Group. Rates of allergic reaction to these ingredients are reported as high as 34%. Moreover, they have become ineffective at preventing infections because after of decades of widespread use most bacteria are resistant to them.
DO NOT use lanolin containing products like Aquaphor. Lanolin is sheep sebum; sheep make to condition their wool. This animal product is widely used in skin care and the rate of allergy to it is rapidly increasing. A recent study of over a thousand children found 66% of those with eczema and 29% without eczema had a skin reaction to lanolin. Also of note, lanolin has never been shown to speed the healing of skin. So why use it?
We know when the skin is injured it is a less effective barrier, allowing more of whatever you are putting on it to be absorbed thereby increasing the risk of irritation or allergy. For raw skin, steer clear of these and other common allergens.
What can you use?
One option is plain petroleum jelly, such as Vaseline. Yes, it is made from fossil fuels, but it has a low risk of allergy or contamination, and studies show it successfully occludes the skin to prevent the loss of water from healing skin. Another option is RESTORE Healing Balm, a plant-based ointment. This product was made by a dermatologist (me!) to give people a better option to help heal injured skin. It is made from castor seed oil and plant-based glycerin. When combined, these natural ingredients promote skin healing, reduce irritation, and restore normal skin barrier function. In a study it was shown to outperform Aquaphor in the healing of skin. Check out the study here.
Once the wound is covered, then get an ice pack on the area to prevent bruising. If you get a large bruise or the area is sore, continue icing every few hours for the first 2 days.
How long do I have to wear a bandage?
It depends on the part of the body that is injured and how quickly you heal. For the face, plan on ointment and bandage for a week. If it is a leg or foot, expect more like a month. When in doubt reapply and re-bandage! By keeping the wound covered you will speed the healing and protect the healing skin from the sun. If an injury gets tan while healing, it can permanently darken the scar making it more noticeable.
Once the wound is healed over and there is new intact pink skin you can stop the ointment/bandage combo and switch to a silicone tape or gel. Silicone is the only topical treatment that has been shown to decrease redness and the thickness of scars when used during the first 90 days of healing. If using the gel, apply twice a day. If using the silicone scar strips, apply and leave on until it stops sticking and then replace it. For the silicone gel used in the morning, I recommend one with sunscreen, like Silagen.
After 30 days of silicone, if you are concerned about how the injury is healing, make an appointment with a dermatologist who specializes in the treatment of scars. Early intervention with scars allows for better outcomes. I will start treatments on scars as soon as the skin is intact and have found that fewer treatments are needed when treating a new scar versus an old scar. Options include surgical revision, injections and lasering for color or texture issues. These treatments are tailored for the person’s skin type and the type of scar.