Hydration and occlusion treatment for hypertrophic scars and keloids. A comparative study evaluating the tolerability and efficacy of two topical therapies for the treatment of keloids and hypertrophic scars. The effects of onion extract on hypertrophic and keloid scars. A Randomized, Controlled Trial to Determine the Efficacy of Paper Tape in Preventing Hypertrophic Scar Formation in Surgical Incisions that Traverse Langer's Skin Tension Lines The Efficacy of Topical Silicone Gel Elastomers in the Treatment of Hypertrophic Scars, Keloid Scars, and Post–Laser Exfoliation Erythema Effective symptomatic treatment for severe and intractable pruritus associated with severe burn-induced hypertrophic scars: A prospective, multicenter, controlled trial. The incidence of hypertrophic scar formation in wounds closed with subcuticular nylon or polyglycolic acid (Dexon). Evaluation of a self-adherent soft silicone dressing for the treatment of hypertrophic postoperative scars. Successful Treatment of Earlobe Keloids with Imiquimod after Tangential Shave Excision Prophylactic Treatment of Deep Dermal Burn Scar to Prevent Hypertrophic Scarring Using the Pulsed Dye Laser: A Preliminary Study Clinical Evaluation of a New Self-Drying Silicone Gel in the Treatment of Scars: A Preliminary Report Role of silicone derivative plus onion extract gel in presternal hypertrophic scar protection: a prospective randomized, double blinded, controlled trial. Possibilities of scar treatment after thoracic surgery. Comparison of efficacy of silicone gel, silicone gel sheeting, and topical onion extract including heparin and allantoin for the treatment of postburn hypertrophic scars. Early postoperative single treatment ablative fractional lasing of Mohs micrographic surgery facial scars: a split-scar, evaluator-blinded study. Phase 2 Cross-Over Multicenter Trial on the Efficacy and Safety of Topical Cyanoacrylates Compared with Topical Silicone Gel in the Prevention of Pathologic Scars Efficacy of Contractubex gel in the treatment of fresh scars after thoracic surgery in children and adolescents.
In 31 patients with hypertrophic scars or keloids , a side by side test was carried out to check the efficacy of an occlusive dressing technique using cream which did not contain silicone oil , versus a simple application of vaseline , used as a control . In all cases , the cream treated areas of scar and keloid demonstrated a remarkable improvement over that of the vaseline treated area . These findings strongly suggest that the mechanisms of hydration and occlusion are the main basis of the therapeutic action of this method in treating hypertrophic scars and keloids BACKGROUND Onion extract gel ( OE ) and 0.5 % hydrocortisone , silicone and vitamin E lotion ( HSE ) are two over-the-counter preparations used to enhance the cosmesis of keloids and hypertrophic scars . OBJECTIVE To determine the tolerability and efficacy of OE versus HSE versus placebo in subjects with keloids and hypertrophic scars . METHODS Thirty subjects ( > or = 18 years ) with keloids or hypertrophic scars were r and omly assigned to one of three study preparations for 16 weeks . Scar volume was measured at baseline and weeks 4 , 8 , 12 and 16 . Subjects and blinded investigators assessed scar parameters ( in duration , erythema , pigmentation alteration , pain , itching , tenderness and cosmetic appearance ) and patient satisfaction at each visit using a visual analog scale ( VAS ) . Data analysis included : mean percentage change ( MPC ) for subjects completing the study ( n = 15 ) ; the mixed model test to determine differences between the groups over time ; and the Kruskal-Wallis test for the analysis of differences in subjects ' satisfaction within the three groups over 16 weeks for subjects who completed at least one follow-up visit ( n = 21 ) . RESULTS All three preparations were well tolerated with the exception of a mild acneiform-like eruption in one OE patient . Significant improvements were obtained with OE in volume , length , width and in duration and with  HSE in volume , length , in duration , erythema and pigmentation alteration . There was a trend showing that a higher percentage of subjects were satisfied with OE than with HSE or placebo . The Mix Model Analysis ( MMA ) showed significant improvements with OE over placebo in investigator cosmetic assessment , lesion in duration , pigmentation and tenderness and with  HSE  over placebo in investigator cosmetic assessment , lesion in duration , pigmentation and erythema . Improvements in erythema and pigmentation were significantly greater in HSE than in OE . CONCLUSION Both OE and HSE were more effective than placebo in the management of hypertrophic scars and keloids OBJECTIVE To evaluate the therapeutic activity of topical onion extract in gel form on  hypertrophic and keloid scars  , focusing on problems such as elevation , redness , hardness , itching and pain . METHOD This comparative prospect i ve study assigned 60 patients to three groups . Group I was treated with onion extract alone , group 2 with silicon gel sheet alone and 3 group with a combination of onion extract and silicon gel sheet . RESULTS In the group comparisons , a significant difference was observed at the end of six months in the colour parameter between group I and group 2 and in the height parameter between group I and group 3 ( ANOVA post-hoc Tukey 's test , p<0.01 and p<0.05 respectively ) . The onion extract was more effective in relation to scar colour , while the silicon gel sheet was superior in decreasing the height of scar ( paired sample t-test , p<0.001 ) . In addition , the most effective therapeutic results were obtained when the silicon gel sheet treatment was combined with onion extract in group 3 . CONCLUSION Onion extract improved hypertrophic and keloids scars via multiple mechanisms . However , it was statistically ineffective in improving scar height and itching . For this reason , onion extract therapy should be used in combination with an occlusive silicon dressing to achieve a satisfying decrease in scar height Background : How a scar is managed postoperatively influences its cosmetic outcome . After suture removal , scars are susceptible to skin tension , which may be the trigger for hypertrophic scarring . Paper tape to support the scar may reduce multidirectional forces and prevent hypertrophic scarring . Methods : Seventy patients who had undergone cesarean section at the Royal Brisbane and Women 's Hospital were r and omized to treatment and control groups . Patients in the control group received no postoperative intervention . Patients in the treatment group applied paper tape to their scars for 12 weeks . Scars were assessed at 6 weeks , 12 weeks , and 6 months after surgery using ultrasound to measure intradermal scar volume . Scars were also assessed using the International Clinical Recommendations . Results : Paper tape significantly decreased scar volume by a mean of 0.16 cm3 , ( 95 percent confidence interval , 0.00 to 0.29 cm3 ) . At 12 weeks after surgery , 41 percent of the control group developed hypertrophic scars compared with none in the treatment group ( exact test , p = 0.003 ) . In the treatment group , one patient developed a hypertrophic scar and four developed stretched scars only after the tape was removed . The odds of developing a hypertrophic scar were 13.6 times greater in the control than in the treatment group ( 95 percent confidence interval , 3.6 to 66.9 ) . Of the 70 patients r and omized , 39 completed the study . Four patients in the treatment group developed a localized red rash beneath the tape . These reactions were minor and transient and resolved without medical intervention . Conclusions : The development of hypertrophic and stretched scars in the treatment group only after the tape was removed suggests that tension acting on a scar is the trigger for hypertrophic scarring . Paper tape is likely to be an effective modality for the prevention of hypertrophic scarring through its ability to eliminate scar tension Background Dermatix is a Food and Drug Administration ( FDA ) -registered substantial equivalent to silicone gel sheeting for the prevention and management of hypertrophic scars and keloids . Methods A 90-day prospect i ve study evaluated the efficacy of Dermatix , silicone gel sheeting , and a combination of these treatments in improving scars for 30 patients . Each patient had a bilateral scar that served as an untreated control . The outcome measures included profilometry analysis of scar topography before and after punch biopsies of the control and treated scars , symptoms associated with the scars , and patient evaluations of the ease of treatment . Results The results showed better resolution and improvement of scars with Dermatix treatment or the combined use of Dermatix and silicone gel sheeting than with silicone gel sheeting alone .  Wound erythema was reduced , and collagen architectural reorientation was demonstrated histologically . Patients rated Dermatix as easier to use than silicone gel sheeting . Both Dermatix and silicone gel sheeting reduced symptoms of itching , irritation , and skin maceration . Conclusion The results of this study indicate that Dermatix is a useful treatment for the management of abnormal scarring BACKGROUND Burn-induced hypertrophic scars are disfiguring and can be associated with severe and intractable pruritus . No effective treatment modalities are currently available for symptomatic control of pruritus for most patients . We assessed the effect of the Antipruritic Hydrogel ( CQ-01 ) in the symptomatic treatment of severe and intractable pruritus associated with burn-induced hypertrophic scars in a prospect i ve , multicenter , controlled trial . METHODS A pilot study was conducted in healthy adult volunteers to identify the most appropriate hydrogel formulation . A selected preparation called Chongqing No. 1 ( CQ-01 ; a guar gum-based hydrogel impregnated with peppermint oil , menthol , and methyl salicylate by a nanoemulsion ) , showed an excellent symptomatic relief in an exploratory study in 2 patients with intractable pruritus . A statistically powered , prospect i ve , multicenter , controlled study was then conducted in 74 patients to evaluate the efficacy and safety of a 24-h application of CQ-01 compared to a gel control and a negative control on three separate areas in each patient . Symptom assessment was based on our visual analog JW scale ( ranging from 0 to 100 ) at baseline and various time points up to 7 days after application . Follow-up studies were conducted to determine the reproducibility of CQ-01 in repeated applications . RESULTS Of the 74 enrolled subjects , the only observed adverse event was skin irritation reported in 6 patients ( 8 % ) and resolved shortly after gel removal . Compared to the baseline , the gauze negative control had a mean JW score reduction of 7 ; while the gel control and CQ-01 had a drop of 18 ( p<0.001 ) and 36 ( p<0.001 ) , respectively . The CQ-01 clinical effect was significant for up to 3 days and waned slowly from 3 to 7 days . There was no statistical correlation between the treatment response and any of the demographic , patient or burn-related factors . Further studies showed a trend that repeated applications might be more effective , suggesting the absence of tachyphylaxis . CONCLUSIONS This prospect i ve , multicenter , controlled study showed that this novel hydrogel CQ-01 is safe and provides significant symptomatic relief for severe and intractable pruritus associated with hypertrophic scars , an unmet medical need for these patients . This effect is independent of the etiology of the burn trauma , extent of the scarring , and duration of the scar formation Abstract Subcuticular skin closure with absorbable material s is particularly valuable in paediatric and day case surgery , obviating the trauma and inconvenience of suture removal . Dexon , which is absorbed by hydrolysis with minimal tissue reaction , would seem to be an ideal material to use but it has been suspected of causing hypertrophic scars ( Cox and Simpson , 1975 ; Watts , 1975 ) . This trial was arranged to test this suspicion , comparing Dexon with a chemically inert material , nylon OBJECTIVE The primary objective was to compare the efficacy of a self-adherent soft silicone dressing ( Mepiform ) with ' left-alone ' management of hypertrophic scars using theVancouver Scar Scale . Secondary objectives were to follow photographs of the scars , patients ' opinions of the scars , and doctors ' and patients ' assessment s of the overall dressing performance , safety and tolerance . METHOD An exploratory open r and omised controlled clinical investigation was undertaken on 11 female patients aged 21 - 43 years with postoperative scars ( nine following breast surgery , two following lower abdominal-glutealplasty ) . Treatment was initiated between two weeks and two months ( mean 4.7 weeks ) after surgery . Ten patients completed the 12-month investigation ; one patient in the treatment group discontinued for personal reasons . RESULTS All parameters in the Vancouver Scar Scale improved in both groups , although patients treated with the soft silicone dressing showed greater and more rapid improvements compared with the non-treated patients , while their assessment s of the condition of the scar were more favourable . Medical staff rated the overall dressing performance as ' very good ' or'good ' . One adverse event was reported -- local skin irritation at the site of the scar . CONCLUSION The results suggest that patients treated with the soft silicone dressing experienced greater and more rapid improvements compared with non-treated patients . These results concur with those of previous studies . The fact that Mepiform is self-adhesive and causes limited damage to the stratum corneum on removal gives it an added value compared with non-adhesive silicone gel dressings BACKGROUND The treatment of earlobe keloids has historically been suboptimal ; characterized by discomfort , poor response , and high rates of recurrence . Keloids are characterized by increased fibroblast activity in the setting of an altered cytokine profile . OBJECTIVE To investigate whether topical imiquimod 5 % cream applied postoperatively after tangential excision can prevent recurrence of earlobe keloids . METHODS AND MATERIAL S Four patients with a total of eight large pedunculated earlobe keloids ( five of which were recurrent lesions ) were treated with debulking by tangential shave excision followed by daily application of imiquimod 5 % cream for 6 weeks . RESULTS At 6 and 12 months post-treatment there was an excellent cosmetic result and no evidence of recurrence in any of the lesions . Patients with keloids that were itchy and painful  were completely asymptomatic at the conclusion of the study . CONCLUSION In this pilot study , imiquimod 5 % cream following tangential shave excision was efficacious for the treatment of earlobe keloids . Further study is warranted to confirm the utility of imiquimod 5 % cream in the treatment of earlobe keloids , as illustrated herein The pulsed dye laser , by selectively targeting blood vessels , has been used to treat established hypertrophic scars with good effect . This prospect i ve clinical study aims to assess the feasibility of treating deep dermal burn wounds prophylactically before the formation of hypertrophic scars . Patients with burn wounds that took longer than 2 weeks to heal were primarily recruited . Each patient 's burn area was divided into a treated area and a negative control . The area was laser treated with the pulsed dye laser ( Chromos 585 ; SLS , Wales ) twice at 6 weekly intervals . The appearance of the wound at both sites was inspected visually and scored at 6 weeks , and at 3 , 6 , and 9 months . Five patients with six burn sites ( forearm , arm , and back ) were treated . Treated areas achieved better scarring at 6 weeks ( p = 0.04 , paired t-test ) and at 3 months ( p = 0.003 , paired t-test ) . The difference , however , became insignificant at 6 and 9 months . No notable side effects were seen in all patients . Prophylactic treatment of burn wounds with the pulsed dye laser is effective in hastening the resolution of scarring . In the authors ’ opinion , this treatment may revolutionize the traditional method of hypertrophic burn scar prevention , and should be considered early , especially for patients who are prone to hypertrophic scarring , and in areas where hypertrophic scarring are common Topical silicone gel sheeting and intralesional steroids are the only evidence -based recommendable forms of treatment to control the quality of a scar . The advantages and disadvantages of both are well known . This study was undertaken to verify the efficacy of a new topical silicone treatment : a self-drying spreadable gel that needs no means of fixation and can not be seen because of complete transparency . Fresh surgical scars treated with the tested product showed significantly better outcomes than those untreated in a prospect i ve trial involving a group of 160 patients .  Patient compliance was particularly good , especially for scars on exposed areas such as the face , where the traditional gel sheeting is frequently discontinued at an early stage by patients who object to its visibility . The results of the self-drying silicone gel have indeed been satisfactory . Considering the effective results obtained and the good patient compliance , the authors currently rate this concept of treatment as the first choice for preventing hypertrophy of recent scars Use of silicone derivative and onion extract had been reported in the prevention of hypertrophic scarring . Our experience showed the preventive use of silicone derivative plus onion extract gel on hypertrophic scars after median sternotomy . In a r and omized , double blinded , placebo-controlled study , 60 patients after median sternotomy incisions were separated into two groups . All patients were treated either with silicone derivative plus onion extract gel ( Cybele ( ® ) scagel ) or placebo gel twice daily for a total treatment period of 12 weeks . During each visit , pain and itching scores were grade d by the patients and scar characteristics were observed by surgeons using the Vancouver scar scale . Pain and itch score values from patients ' who applied silicone derivative plus onion extract gel was less than another group ( P < 0·05 ) . Pigmentation was significantly different between two groups ( P < 0·05 ) and the reduction of scores on vascularity , pliability , height in treated group was not superior to the untreated group . No adverse events were reported by any of the patients . A silicone derivative plus onion extract gel is safe and effective for the preventing the hypertrophic scarring after median sternotomy During a ten year observation period it was found that scar formation after thoracic surgery is influenced by various factors : metabolism , operative technique and factors of a general nature . On the basis of these findings , a study was carried out to investigate the effect of the scar-specific Contractubex gel ( Merz+Co . , D-Frankfurt/Main ) , containing 10 % onion extract , 50 U sodium heparin per g of gel and 1 % allantoin , in the treatment of children who underwent thoracic surgery and to evaluate its effect on scar development . Before and during the six-month treatment period , both macromorphology and scar colour were assessed ; furthermore , a global evaluation of the therapeutic result was made . Additionally , the scars were characterized after a six-month treatment-free follow-up period . The results of 38 Contractubex-treated and 27 untreated patients were compared . In the treated scars , the global evaluation of the therapeutic result was better than in the untreated scars . In the Contractubex group , the rating was " good " and " very good " in 84 % of cases , as compared to 59 % of the untreated cases . In the treated group , the increase in scar size was markedly lower than in the untreated patients . The treated scars showed a tendency towards quicker paling than the untreated scars . In the treated group , the conversion of primary physiological scars to unphysiological scars ( hypertrophic or keloidal scars ) was less frequent than in the untreated group . The tolerability of the product was very good in 37 of the 38 treated patients , and good in one patient . All scar-specific effects of Contractubex continued to persist after the end of treatment We compared the efficacy of silicone gel ( Scarfade ) , silicone gel sheet ( Epi-Derm ) , and topical onion extract including heparin and allantoin ( Contractubex ) for the treatment of hypertrophic scars . Forty-five postburn scars were included in the study . Patients with scars less than 6 months from injury were assigned at r and om to three groups each containing 15 scars , and their treatment was continued for 6 months . Scars were treated with Scarfade , Epiderm and Contractubex .  Scar assessment was performed at the beginning of the treatment , and at the end of the sixth month when the treatment was completed by using the Vancouver scar scale . The difference between before and after treatment scores for each three groups was statistically significant . The difference between Scarfade group and Epi-Derm group was not significant ; however , the differences of the other groups ( Scarfade-Contractubex , Epiderm-Contractubex ) were significant . Silicone products , either in gel or sheet , are superior to Contractubex in the treatment of the hypertrophic scar . The therapist should select the most appropriate agent according to the patient 's need and guidelines of these signs BACKGROUND / OBJECTIVES Despite precise surgical technique , some postoperative facial scars will depress and widen over time , likely due to weakened or inadequately replaced collagen fibers in the underlying dermis . The purpose of this study is to evaluate whether a 10,600 nm ablative carbon dioxide ( CO2 ) fractional laser used early in the post-surgical setting results in improved postoperative facial scars after a single treatment session . STUDY DESIGN A prospect i ve r and omized , comparative split-scar study was conducted on 20 subjects between the ages of 20 - 90 . Subjects underwent Mohs surgery for nonmelanoma skin cancer of the face . Subsequent to tumor removal , subjects with a linear scar of 4 cm or greater were enrolled . On the day of suture removal , all subjects had one-half of their scar r and omly selected and treated with a 10,600 nm CO2 fractional laser ( energy = 10 mJ ; density = 10 % ; spot size = 7 mm ; pulse = 1 ) . The untreated scar half served as a control . Scars were re-evaluated 12 weeks later . An independent blinded observer grade d the scar halves with the Vancouver scar scale ( VSS ) immediately prior to treatment and 12 weeks after treatment . Subjects completed a visual analog scale ( VAS ) at the same time points . RESULTS Three months after laser treatment , a significant decrease in VSS and 3 of the 4 of its individual parameters were detected in both control and treated halves of the scar . When comparing the laser group versus the control group , a statistically significant difference was not noted in VSS ( P = 0.31 ) but a statistically significant difference in patient VAS was detected ( P = 0.002 ) . No side effects of the laser treatment were noted . CONCLUSION Facial wounds sutured in a layered manner heal well . Patients prefer early fractional  CO2 lasing of surgical scars , though use of the VSS failed to detect an objective difference between laser and control halves of scars . Conservative laser setting s , a single session treatment , and VSS insensitivity for surgical scars may influence these findings Background Many clinical studies on scar therapy are reported in the literature , but only silicone gel sheeting and corticosteroid injections are supported by accurate prospect i ve controlled studies . This prospect i ve multicenter cross-over phase 2 study tested the effectiveness of a topical cyanoacrylate compared with silicone gel in improving postsurgical scars Methods Patients presenting with symmetric breast scars after augmentation or reduction mammaplasty were enrolled in the study . From the same day as stitch removal , the cyanoacrylate was applied on one side every 3 to 5 days and the silicone gel on the other side twice a day for 3 months . Assessment s of patients and external observers using a visual analog scale were recorded at scheduled visits during 1 year , and scars were photographed . Objective evaluations included measurements of scar width , length , and elevation . The statistical significance of objective parameter modifications was analyzed using the Wilcoxon test Results Positive effects of both tested products were observed during the scar maturation process , and final scars of good quality were achieved without any major adverse effect . The topical cyanoacrylate proved to be more efficacious in preventing scar widening , and this result was statistically significant Conclusions The tested topical cyanoacrylate had a positive effect on the scar maturation process at least comparable with that of topical silicone gel Scar development was investigated in 45 young patients who had undergone thoracic surgery . Patients were r and omly assigned either to a group which was treated topically with Contractubex gel ( Merz + Co. , D-Frankfurt/Main ) , containing 10 % onion extract , 50/U of sodium heparin per one g of gel and 1 % allantoin , or to a group receiving no treatment . The treatment began on average 26 days after the operation and was continued for one year . The scars of all treated and untreated patients were evaluated at monthly intervals . The appearance of the scar , including scar type and scar size as well as scar colour , was assessed by the physician . A reduction of the increase of scar width was seen in the Contractubex-treated group as compared with the untreated group . Further , physiological scars and skin-coloured scars were more frequent in the treated group than in the untreated group . Hypertrophic or keloidal scars were less frequent in the treated group . No differences in scar length and scar height were seen . At the end of the observation period , the clinical course of scar development was rated as " very good " or " good " in more than 90 % of the treated patients , " good " in less than 40 % and " moderate " or " bad " in more than 60 % of the untreated cases . The tolerability of the drug was " good " or " very good " in all cases . In conclusion , Contractubex gel is useful in scar treatment after thoracic surgery
Contractubex showed best results in the prevention of pathological scars .
BACKGROUND The treatment and prevention of  hypertrophic scars and keloids  represents a special challenge particularly in plastic surgery .
Given their simple , non-invasive and painless application , topical preparations are an attractive therapeutic option .
On the part of the patients , the efficacy in prevention of and therapy for hypertrophic scars and keloids of these topical preparations is regularly question ed .
The clarification of this issue is subject of this review .