This question comes from Iman who asks what scar creams are available apart from Vitamin E and Silicone?
This is an age old question and surprisingly it’s still a new field of dermatology that is yet to be revolutionized.
We’re still using old technology from the 70s aka the humble silicone gel sheets. But that’s because it works.
Scars are bothersome to us humans because they affect our self-esteem in public. Scars can be large, look red, itch like hell, and feel hard to the touch which can affect our dexterity.
Scarring is the end process of skin healing following trauma be it a cut, burn, graze etc. Skin goes through three stages:
1) inflammation (things get swollen through extra blow flow to the area, pus forms as a by-product)
2) granulation (new blood vessels form, the structural components are laid down) and
3) matrix remodeling (a fancy word for collagen being packed down)
It’s this third stage that causes often gets out of hand and produces excess collagen and hence the raised look of a scar. The story gets worst in the case of keloid scars as they not only regrow but grow beyond the border of the original damage. See images :
(Left) Keloid Scars often overgrow the border of the damage site whereas (Right) Hypertrophic scars stay within the border and are less aggressive in growth.
Why do scars even occur? From a cave-man survival perspective…should we ever get a laceration or trauma, the best thing to ward of infection and ensure quick receovery is to have an inflammatory response that tells the body to lay down plenty of collagen to fill up the exposured areas. It’s a biological response. I read somewhere that only certain reptiles can actually rebuild skin to the exact specifications as the original!
So back to humans. Silicone gel sheets are the go-to. They work by occluding (form a protective barrier) the scar and adding hydration. Left on for at least 12hours a day for 6-12months. Downside is the impracticable nature of strapping on a silcone sheet to your body. Especially if it’s on flexure points like elbows or chin.
Compression Garments/Pressure therapy has been proven to reduce the size of scarring especially those across large areas of the body. They are thought to work by mechanical pressue on the underlying blood vessels thereby restricting blood flow and hence collagen formation at the damage site. Another theory is they provide the shear forces to help re-organize new collagen. The downsides include the tedious nature of putting them on and off-they’re tight!; must be worn for 23 hours each day for up to one year; needs replacing every 2-3 months to maintain their pressure ~25-30mmHg. Here are some photos:
The combination of compression with silicone is superior to either alone and so there are brands they incorporate silicone into pressure garments.
Now for the white elephant in the room: Vitamin E oil. Known as an antioxidant, the main one in the skin in fact, people including doctors have always used it on anecdotable eveidence that it helps scars-but does it? I read lots of articles on it and nowhere is there solid proof that it works.
If anything it may cause some irriation. If used too early on fresh scars it can actually weaken the scar and cause the scar to widen. Its possible the type and strength of Vitamin E count for something…one study was using 320 IU per gram of cream. Typical Invite E cream in pharmcies is only 100IU per gram (Invite E oil is 25IU per drop).
Not surprisingly scientists decided to use Vitamin E with silicone gel sheets to see what wopuld happen and results blew them away-the combo dramatically improved scar colour, size and appearance.
Now I could go on about the various other remedies out there but not much evidence exists so I’ll just briefly list them here:
- Onion extract (only slightly better than using Vaseline!)
- Imiquimod 5% (needs more research, some promise)
- Vitamin A (aka retinoic acid; reduces scar sizes, can be a teratogen if absorbed into the body, needs more research)
More invasive options do exist however…
- surgical excision (cutting it out) but for keloids, they recur in 45-100% of cases (reserve for resistant scars)
- Steroid injections (corticosteroids): first line therapy for keloids. Response rate 50-100%, Recurrence of 9-50%. Painful. Side effects: discoloration, dimples, spider veins.
- Radiotherapy: most effective treatment for keloids but high exposure to radiation. Response rate: 10-94%, Recurrence rate: 50-100%.
- Laser (carbon dioxide, argon, flashlamp-pumped pulsed-dye): conflicting results. more research needed.
- Cryotherapy: flattens keloids after two sessions. Side effects: permanent skin discoloration, pain, skin shrinkage. reserved for small scars.
An unusual observation is the use of paper tape to hold together fresh incisions made by a surgeon, used for several weeks, seemed to be “useful”. albeit not as effective as silicone, it could serve the purpose of prepping the skin prior to silicone gel sheets.
So for our friend Iman, I think sticking to silicone gel sheets like Scar FX or Cica-Care is her best bet with the addition of some Vitamin E oil (optional) and a pressure garment.