Silicones do work on various types of scars. They are the only proven effective OTC products available. This treatment, commonly referred to as ‘The Golden Standard in Scar Treatment’ is non-invasive and easy to use. But how do they work?

Various theories circulate on the mechanism of silicone scar sheets and gels. Some state that the scar improving effects are due to pressure administered by the sheets. Others say that the reduced elevation and redness of scars are the result of a static electric field created by the silicones.

But there’s no evidence these assumptions are right. Also theories on improved oxygen supply, or an increased blood flow as a result of administering silicones have not been proven. Hydration does seem to play a major role but there’s more to it than simply moisturizing scar tissue.

According to various experts it is occlusion which is the key to the efficacy of silicone scar treatment. To understand we have to take a closer look at the water retaining function of the skin.

Healthy skin conserves water and functions as a barrier to microbial infection. The outermost layer of the skin (stratum corneum) normally contains water and is responsible for water conservation, but its function is disrupted when the skin is damaged.

“After a full-thickness wound, transepidermal water loss (TEWL) is increased and can take longer than 1 year to recover to basal levels. In addition, this water loss (TEWL) is greater with hypertrophic scars and keloids than with atrophic scars or normal skin [1].”

Water loss caused by skin injury leads to dehydration of the tissue which, on its turn, is thought to stimulate the production of small proteins (cytokines). These proteins are theorized to lead to changes in the skin (dermis) and increased scar tissue creation (collagen production) by cells that play a major role in wound healing (fibroblasts).

Although application of silicone sheeting to skin causes hydration of the stratum corneum, the extent of hydration is less than that produced by a plastic film, and the increase in hydration compared with normal skin decreases after repeated treatment [2].

These results have been interpreted to suggest that the semi-occlusive nature of silicone gel sheeting improves scars by providing adequate but not excessive hydration [2]. A plausible explanation for the mechanism of action of silicone-based products, therefore, is that occlusion causes a decrease in TEWL and normalizes the hydration  state of keratinocytes, which then signal dermal fibroblasts to downregulate extracellular matrix production.[3]

Or in other, less technical words, silicone sheeting is thought to provide the exact right amount of occlusion which restores the water balance in the skin and scar tissue. Certain processes in the scar tissue are more balanced out which results in less abnormal scar tissue creation.

[1] Suetake T, Sasai S, Zhen YX, Ohi T, Tagami H (1996) Functional analyses of the stratum corneum in scars: Sequential studies after injury and comparison among keloids, hypertrophic scars, and atrophic scars. Arch Dermatol 132:1453–1458

[2]Suetake T, Sasai S, Zhen YX, Tagami H (2000) Effects of silicone gel sheet on the stratum corneum hydration. Br J Plast Surg 53:503–507

[3] Evolution of Silicone Therapy and Mechanism of Action in Scar Management Thomas A. Mustoe. Aesth Plast Surg (2008) 32:82–92

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The use of topical vitamin E for scars is probably the most popular home treatment. There’s an overwhelming amount of anecdotal proof. Take a look at any forum, website, or other source where scar treatment questions are answered and there’s a big chance someone states vitamin E to be the best option to treat a scar. However, there’s no scientific proof confirming this statement.

A few studies on this matter have been conducted the past years. This particular study among 159 test persons, of which the report was published in The Journal of Burn Care and Rehabilitation in 1986 demonstrated that;

“Those in the vitamin E group showed no noticeable improvement in the size, thickness or appearance of their scars by the end of the study.

The conclusion of a more recent study (1999) conducted by the University of Miami stated that:

“This study shows that there is no benefit to the cosmetic outcome of scars by applying vitamin E after skin surgery and that the application of topical vitamin E may actually be detrimental to the cosmetic appearance of a scar.

In 90% of the cases in this study, topical vitamin E either had no effect on, or actually worsened, the cosmetic appearance of scars. Of the patients studied, 33% developed a contact dermatitis to the vitamin E. Therefore we conclude that use of topical vitamin E on surgical wounds should be discouraged.”

That’s why, despite the many positive reviews, the topical use of vitamin E on scars is discouraged. Alternatives are moisturizing agents (such as Vaseline) and silicone gel. More on silicone scar treatment.

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This may sound unbelievable but just like salamanders are able to grow back their tails medical science is now capable of growing back fingertips and other tissue. Several cases have demonstrated tissue regeneration in human beings.

Here’s a short Youtube video about how doctors were able to regrow the severed top part of a little boy’s thumb with the use of wound tissue regeneration.

Acell, the manufacturer of innovative tissue regeneration products (MatriStem) states that their products “promote cell development and regeneration of site specific tissue, may recruit adult progenitor cells, and reduce scarring and restore tissue to its normal state and function.”

Progenitor cells (like stem cells) have a tendency to differentiate into a specific type of cell. In contrast to stem cells, however, they are already far more specific because they have the ability to differentiate into site specific tissues such as muscle, skin, tendons, and bone.

Commonly two types of tissue regenerative agents are used. Wound powder and biodegradable scaffolds which are matrix structured dressings which foster the regeneration of new tissue that resembles the original tissue in structure and function.

According to the wound healing page on Wikipedia: “biodegradable scaffolds inhibit wound contraction, thereby allowing the healing process to proceed towards a more-regenerative/less-scarring pathway.”

Problematic wounds such as diabetic, venous, arterial, and pressure ulcers, traumatic wounds, first and second degree burns, and surgical wounds can benefit from this fairly new type of treatment.

Since they are said to reduce scarring and even prevent scars from developing, as impossible as it sounds, patients might want to ask their surgeon, dermatologist, or other health care professional about this treatment. MatriStem Wound Matrix is available on Amazon but can only be purchased by keepers of a pharmacy license.

Read more about the miraculous opportunities modern medical science has to offer in this CNN article: Woman’s persistence pays off in regenerated fingertip. There are some tips on how to be a proactive patient and how to contribute to getting the most optimal treatment available today. Or as stated in the article; realize your doctor doesn’t know everything.

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Thanks to biopharmaceutical company Renovo we could possibly speak of a small revolution in the scar treatment sector.

The leader in the discovery and development of drugs to reduce scarring, improve wound healing and enhance tissue regeneration aims to be first to market with a scar reduction pharmaceutical drug in the US and Europe.

The product, brand name Juvista, is administered before surgery and is designed to prevent scars. More about this medicine here. The company has successfully trialled a new formulation of Juvista that is specifically designed for children.

“This trial has been extremely successful,” chief executive Mark Ferguson said.

Whilst the new formulation is designed for children, it was tested in eighty four healthy male and female adult volunteers.

Four incisions were cut under the arms of the volunteers, and they were treated in a double blind, placebo controlled study of the safety and efficacy of Juvista and Juvista Paediatric on scar appearance after 12 months.

Standardized photographs were taken and scars evaluated over regular intervals by a panel of experts.

According to Ferguson, more than half of the wounds were deemed by the panel of experts to have been improved by Juvista.

More information on Juvista and other upcoming products such as Prevascar on the Renovo website. Original source of this article.

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Cuts, and abrasions as a result of bumps and falls are a natural part of children’s lives. Many times the wounds are superficial but in some cases stitches or sutures are needed. In these cases, as well as in case of lacerations and chicken pox, parents may become concerned about scars. Children may become self-conscious. Especially when a child’s scar is located on a prominent location such as the face. Read on to learn about the best way to treat scars on children.

Here are some things for parents to know:

Scabs
Children are known to pick off scabs. This should be avoided if possible. In fact, scabs should best be prevented at all. Scabs contribute to scar creation. After a scab has fallen off the scar commonly stays red and bumpy for a while (this redness may last for a few months). When a wound is kept covered and moist it won’t scab, and heal more quickly which diminishes the risk on scarring. More info here.

Effective Treatment
The best non-invasive option available are silicone sheets or gels. Silicones have demonstrated to help to reduce itch, pain and sensitivity and render scars flat, soft and
supple. Especially useful for kids who are more prone to keloids such as children with dark skin because silicones help preventing such scars.

Difficulties
A difficulty of using silicone sheets on children is adherence. Silicone sheets can be difficult to keep attached. Especially in toddlers because they are so movable. I commonly recommend using ScarAway sheets but for young children you might want to use Cica Care sheetsbecause these are stickier.

Another solution is to use a silicone gel cream (a liquid that dries to a thin transparent film). According to medical evidence these ointments are (slightly?) less effective than sheets or patches. According to many this is because sheets apply pressure but medical science isn’t convinced about that. Here’s a list of commercially available silicone gel creams.

Polyurethane Dressings and Pressure Garments
Other over the counter products backed by clinical evidence are polyurethane dressings (although less evidence available and probably slightly less effective), and compression garments (the formerly used method, especially in case of burn scars)

Other Measures
Gently massaging on and around the location of the scar tissue is thought improve circulation, which should minimize scarring. Massage is also used to make surly tissue more supply and pliable.

Don’t forget to protect your child’s scar against sunshine with sunscreen and/or clothing. This is important because UV radiation will worsen the scar and may reduce the distortion of skin color and texture. Thin clothing only has a very low SPF so in most cases sunblock is a must. It is commonly recommended to apply sun block on the area for a prolonged period. Some dermatologists recommend to apply sunblock every day for a year because scar tissue pigments differently. Sometimes it’s the change in pigmentation that is more visible than the scar itself.

A popular product is Mederma for Kids. Although there’s minimal evidence this onion-extract based product really fades scars, there is a vast amount of positive anecdotal reports. But this is also the case for vitamin E oil.

Avoid Vitamin E Oil
Pure vitamin E oil, e.g. from capsules should be avoided. Especially when wounds or scars are fresh. Studies have shown vitamin E oil to cause rash or other skin irritation in about one third of the test persons. In the worst case this may worsen scar appearance.

Do children scar more easily?
Well, the opinions differ. I think they don’t, except for the fact that they may be injured more easily because it’s a part of growing up. I guess it depends on the severity, depth, of the wound and the healing process. Also genetics are of major influence because the tendency to scar is hereditary. On the other hand I think wounds and scars tend to heal more quickly in children and thus scar appearance may be less prominent. This because children have a young, elastic, and resilient skin.

Upcoming innovative medicine designed to prevent surgical scars
In the near future a new medicine designed to prevent post-surgery in children will be launched. Read more about it here.

Photo by wsilver

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Mole removal is, in many cases, done for cosmetic reasons. The downside of his procedure is the reasonable chance on a scar (in many cases scarring after mole removal is inevitable). Though, most people will agree that a well healed scar is preferred above a big, prominent mole.

This post is about how to prevent a scar and/or make the scar’s appearance as less obtrusive as possible after mole removal.

Regarding mole removal scar treatment two things are important. The first is wound care. The main rule is that the faster a wound heals the less scar tissue will develop.

Make sure to avoid complications such as wound infections or other wound healing delay. Moisturize. Avoid drying out of the wound. Dried out skin cells will die which delays the healing process. Not convinced? Read more about it here.

Keep the wound clean and covered. Monitor the process and in case of problematic issues take action. (e.g. use an antibiotic ointment or Medihoney wound paste when the wound gets infected) In most cases this should be sufficient.

Now that the wound has healed properly the scar can be treated. When a wound has closed and regenerative tissue has grown we speak of scar treatment. Before that it’s wound treatment. This matters because silicone sheeting should be used only after the wound has closed.

This gets us to the second important item of mole removal scar treatment; silicones. Use silicone sheets, or if you prefer a silicone cream, to treat the scar. These are the only empirically proven effective, non-invasive, over the counter products. Here’s more info, links to clinical studies on this subject, and my personal experiences.

The scar, or potential scar, will not only flatten, soften, become more pliable, and loose its red or purple color but the risk on excessive scar tissue (hypertrophic scars or keloids) will also decrease by using silicones.

For optimal results the sheets should be worn for at least 12 hours a day (or night, which may be more convenient in case the location of the removed mole is visible e.g. on the face).

Sheets have demonstrated to be more effective than their liquid variants. On the other hand, the liquid variants (such as Kelo-cote and ScarAway serum) are easier to use. They dry to a thin film after they are applied and are far less noticeable. I myself used the sheets during the night and the cream on daytime on my face. I used the sheets as much as possible on scars covered by clothing.

Gently massaging the scar tissue may also help as well as using sunscreen to protect it from harmful UV radiation (this is a must). Also keep in mind not to over-stretch the fresh scar because the pressure involved may widen it.

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Biodermis, Epi-derm silicone scar sheets are made of medical-grade silicones. These doctor-approved scar treatment products are used by hospitals, cosmetic surgeons, burn care practitioners, dermatologists, and other health care professionals.

They are FDA and C.E. (Europe) approved, breathable and permeable which is important because sheets that don’t allow oxygen to pass through may cause maceration. Silicone sheets are clinically proven to be a safe and effective scar treatment option. Epi-Derm sheets are also used for burn scar treatment.

How to use Biodermis Epi-Derm sheets? For optimal results they must be applied for a minimum of 12 hours per day for a period of 8-12 weeks.

Does using Biodermis Epiderm sheets bring side effects? All silicone sheets may cause skin rash although this happens rarely. This is very normal since any topical skin agent may potentially cause contact dermatitis (rash). If this occurs discontinue using Epi-Derm. The only exception is if you develop excessive moisture beneath the sheets which may lead to skin maceration which on its turn could predispose you to a fungal infection.

Are Biodermis silicone sheets any good? Some silicone brands are better than others. Some people gain better results with a certain brand than others. This may depend on skin type, humid or dry climates, and many other circumstances. Biodermis is a quality brand. What also makes it stand out is that Biodermis offers a variety of pre-cut, special shaped sheets. This way there is no need to cut them into the appropriate size yourself.

Studies mentioning Biodermis Epi-derm silicone sheets.
Study comparing the results of Epi-derm with Contractubex. Conclusion:
“Silicone products, either in gel or sheet, are superior to Contractubex® in the treatment of the hypertrophic scar.” Source: burnsjournal.com

Where to buy Biodermis Epi-derm sheets? They can be ordered online at MakeMeHeal and Amazon.

Here’s some info on the various sizes and shapes Biodermis sheets are available in:

Sizes and Shapes of the Biodermis Epi-derm products

Small silicone Patch (size: 5 x 6 cm / 2 x 2.5 in) The patches are only a few inches (max) and are ideal for preventing and treating small hypertrophic and keloid scars. Epitabs are small round and square shaped patches and are the smallest within the Biodermis range.

Standard Silicone gel sheet (size: 12 x 14.5 cm / 4.7 x 5.7 in) Best for mid-sized hypertrophic and keloid scars. Here’s a YouTube video on standard Biodermis Epi-Derm silicone sheets

Large Silicone gel sheet (size: 28 x 40 cm / 11 x 15.75 in) A full-sized sheet, ideal for the reduction of post-burn scarring. Can be wrapped around a limb or cover large scar areas on the torso.

Silicone Gel Strip (size 3.5 x 29 cm / 1.4 x 11.5 in) Strips are recommended for surgical scars such as C-section, tummy tuck, and heart surgery scars. Take a close look at the Biodermis Epi-derm strip in this video.

C strips are specially made for C-section and hysterectomy scars. (size: 3.6 x 15 cm/ 1.4 x 6 in)

Mastopexy shaped gel sheet. (size 32.0 x 9.6 cm / 12.6 x 3.8 in) The Mastopexy form is ideal for breast reduction (mammoplasty) and breast reconstruction surgery, and can be cut to size. Pairs of mastopexy forms and pairs of areola circles are sold separately.

Areopexy shaped sheets. Recommended for the “Lollipop” shaped scar as a result of the Lejour surgical technique used in areola reconstruction, breast reconstruction and breast reduction surgery. Sold in pairs. Can be cut to size.

Areola Circles (size: 7.6 x 1.9 cm / 3 x .75 in) Ideally dimensioned for small hypertrophic and keloid scars resulting from areola reconstruction and breast augmentation surgery. Watch this vid for an indication on how to apply special shaped breast surgery circle shaped silicones. Short video on breast surgery silicone patches

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Keloids (keloidal scars) are thick, lumpy, and grow beyond the borders of the original wound site. Contrary to other scars keloids commonly appear approximately two months after injury.

They may continue to grow and thus cover relatively large areas of skin. They can be itchy and painful. Keloid scar treatment generally is time consuming because they are difficult to treat effectively.

Healthcare professionals make a distinction between minor and major keloids. A minor keloid is a focally raised, itchy scar that extends over normal tissue. It may develop up to one year after injury and does not reduce in size without treatment. A major keloid grows over normal tissue and can continue to extend for years.

There aren’t many over-the-counter keloid scar treatment options because of the low response of this type of scar tissue to treatment. Actually the only home remedy would be silicone sheeting.

However results of silicone sheeting as a keloid treatment are inconstant. Some keloids regress while in other cases silicone sheeting has little to no effect on keloid scars. I guess the best chance on removing a keloid with silicones is to start treating it as it is still small. Silicones are also used as a prevention measure.

When silicone sheeting doesn’t work steroid injections (also referred to as intralesional steroids or corticosteroids) might offer a solution. Although this treatment is relatively safe it can be slightly painful. There are also some possible side effects. The scar may become depressed (skin atrophy), discolorization, and increased scar redness might occur. Steroid injections are usually given each 4 to 6 weeks until the keloid has flattened.

Sometimes steroid injections are administered in conjunction with laser treatment and cryotherapy (freezing). Cryotherapy is done with liquid nitrogen. This treatment may flatten keloid scars but often darkens the tissue.

The problem with surgical keloid treatment is that this type of scar has such a tenacious tendency to grow back. Another problem is that regularly an even bigger keloid may form.

Estimates on recurrence rates vary but are approximately between 45 to 100%. source “When used in combination with steroids the recurrence rate is much better – less than 50%.” (Berman and Bieley, 1995, Urioste, Arndt and Dover, 1999).

Because of these downsides of surgical incision this treatment is often combined with silicone sheeting, surgical taping, compression, radiotherapy, and intralesional steroid injections.

“Surgical excision is the most longstanding, simplest, and only definitive way of removing keloid tissue and reducing the width of the scar. However, its effectiveness as a single mode of treatment is limited and sometimes counterproductive.

In fact surgery for the treatment of keloid scars has been relegated mainly to a second-line therapy for lesions unresponsive to steroids or pressure, and for large lesions requiring debulking.” (Mustoe et al., 2002).

“Citrus limon (lemon). Lemon’s role as an antimicrobial agent has been widely reported. However, despite numerous anecdotal reports, there is only one case report in the medical literature involving the use of lemon juice on keloids.” (Rueter, G. Treatment with lemon juice in the prevention of recurrences of keloid. Zentralbl Chir. 1973;98(16):604-6. )

Aldara iquimod prescription cream has shown to be effective in reducing keloidal scar tissue in some cases. Also dermatix, a steroid cream seems to diminish keloids in a slow but effective pace for some people. Kenacomb is another prescription steroid cream which might be worth a try.

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According to limited sources* bee venom therapy (BVT) is an effective scar treatment. * (Singh, Ratner et al and Lee)

Having scars stung by bees resulted in improvement of scar appearance by reducing, soften, and flatten scar tissue, and toning down the color of the scar.

Of the 18 substances present in bee venom the enzyme hyaluronidase is mainly held accountable for these results. Also internal scar tissue is thought to benefit from this alternative therapy.

“Charles Mraz, a beekeeper in Middlebury, Vermont who has popularized bee venom therapy for the past 60 years, says that it is reasonable to try bee venom therapy in any clinical situation where nothing else works.” [...] “Keloids and other scar tissue are broken down and softened by the substances in the venom, and can flatten out and fade in color.” source: CareCure Forums

This alternative scar treatment isn’t suitable for people who are allergic to bee stings so the first step should be an allergy test.

More info and before and after photo’s of someone who has actually applied bee stings to a scar here: before and after.

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ScarGuard MD ScarCare is a silicone* based cream that dries to a thin film after application. Scarguard Labs (the manufacturer) states that:

“many doctors use ScarGuard MD for old, raised scars, keloids, and to help prevent scar tissue from forming after surgery or injury.”

* (Silicone scar creams are used to flatten, soften, tone down the color, and smoothen thick scars. They are also known to reduce scar pain and itch. )

So does ScarGuard really work? Here’s a short review with the pros and cons of ScarGuard MD.

Scarguard MD differs from other silicone scar creams in that it combines several ingredients. Or, as the manufacturer advertises: “a patented formulation that combines multiple technologies.” Also referred to as “SG5 technology which combines five medically-proven treatments into one easy-to-use solution”. These treatments are:

1)Silicone. Topical silicone is clinically proven to help shrink scar tissue and help prevent new scar formation after surgery.
2)Cortisone. A low dose of hydrocortisone helps reduce irritation.
3)Vitamin E. Helps the healing process by softening and moisturizing the scar and surrounding tissue.
4)Pressure. Slight increase in surface tension is provided.
5)Occlusion. The medical term for adhering to, and protecting, the scar.

A critical note on these five proclaimed medically proven treatments:

Occlusion, especially by silicones, does seem to be effective in scar treatment. However the amount of pressure a silicone sheet, let alone a silicone cream administers is negligible. Vitamin E used as a standalone topical treatment is discouraged by dermatologists because it may cause skin irritation and worsen scar appearance. The benefits of vitamin E as a scar cream component are disputed.

Let’s take a look at the other Scarguard Scar Care ingredients.

Active ingredients: Silicone 12.75%, Hydrocortisone 0.55%, Inactive ingredients: Vitamin E, Specially-formulated flexible collodion.

Collodion is a flexible substance which dries to form a flexible cellulose film when applied on the skin.

Hydrocortisone (or cortisol) is a is a steroid hormone naturally occurring in the human body. It’s function here is to reduce itch. Hydrocortisone is also used in anti itch creams. As most over-the-counter anti itch creams ScarGuard MD also contains less than 1% of this component.

I don’t grasp the reason of the addition of collodion (instead of using silicones).

I’m also wondering why hydrocortisone was added to the formula since silicones have proven to reduce itch themselves. This seems redundant to me. It may be that the limited amount of people who experience skin irritation during the use of silicone creams benefit from using a product that contains hydrocortisone.



I haven’t used this product myself so I can’t speak from experience. So let’s take a look at ScarGuard MD reviews. An analysis of various reviews from different sources yielded the following:

ScarGuard MD Pros

• almost invisible
• dries fast
• easy to apply
• possible to apply makeup on top of the film
• cheaper than the popular Kelo-cote Advanced Formula Scar Gel and ScarAway Silicone Gel Serum

ScarGuard MD Cons

• doesn’t last, may flake, peels off
• looks like paper on your skin very thin, white, translucent paper film
• bad scent, smells like acetone or nail polish remover (smell fades quickly)
• doesn’t seem to work on old scars

My Conclusion:
Since there’s far less silicones in ScarGuard than in some other silicone creams I would personally choose a brand that does contain silicones only. (e.g. ScarAway or Kelo-cote )

However, because of the addition of hydrocortisone ScarGuard might be ideal for people with a very sensitive skin who are prone to sweat rash or other skin irritations.

Alternatives
From the various silicone scar cream brands such as Dermatix, ScarZone, Derma E, ScarFade, Rejuvasil, ScarAway, and Kelo-cote I would choose one of the two latter.

I would order one of these because they contain more (only) silicones. For the best results I would certainly recommend to use them in combination with the clinically proven more effective silicone sheeting. Studies demonstrate that the occlusion is a major component in the effectiveness of these silicone products. The fact that the creams are much easier to apply and wear makes them ideal for particular situations and body locations.

More clinical ScarGuard info in this study report: Efficacy of Scarguard in the Prevention of Scars

Conclusion of this study: “Both patients and investigator noted improved aesthetic effects with Scarguard on the appearance of scars following a minor surgical procedure. [..] study observations were determined in a small group of patients in a nonblinded fashion, further investigation is warranted to confirm these results.”

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