Monday, September 6, 2010

Topical Silicone Gel for Burn Scars

I have read the studies the promote the use of silicone sheets for scar treatment.  I know the claims Mederma and other silicone gel scar treatments make.  What do I tell my patients? 

“It doesn’t matter what you use.  It matters that you use it.  Mederma is non-scented and less greasy than Vit E or cocoa butter.  If that will entice you into doing your dailyscar massage, then use it.”

For most scars, I will stand by the above.  Burn scar are characterized by an increasing occurrence of redness, thickness, stiffness, pain, and itching, and a disturbance in pigmentation and surface roughness.   So when I saw there was a new study looking at the use of silicone gel in the treatment of burn scars, I read it (full reference below).

Burn scars are often treated with intralesional corticosteroid injections, occlusive dressings, custom-made pressure garments, and silicone sheets. 

The silicone sheets, introduced in the early 1980s, have been shown to helpful in improving scar appearance.  The drawbacks of their use include compliance issues on scars in visible areas, difficulty of use for scars on or adjacent to joints, and hygienic issues of prolonged use.  The sheets can trap moisture creating skin irritation or rashes.

The article looks at a topical silicone gel named Dermatix (Meda Pharma, Amstelveen, The Netherlands).  It can be applied easily and dries to form a thin, flexible coating that does not restrict movement.  Unlike the silicone sheets, cosmetics can be applied over the silicone layer to camouflage the scar.

Martijn van der Wal, M.D., VU University Medical Center, Netherlands, and colleagues conducted a randomized, double-blinded, within-subject comparative, placebo-controlled trial to investigate the effectiveness of topical silicone gel in the treatment of scars resulting from a burn injury.

Forty-six scars on 23 patients were included in the study and followed for 1 year.  The mean age of the scars at inclusion was 4 months.   The patients were given two blinded and coded products to be applied two times per day on the two included scars with instructions to not interchange the therapies between the two scars.   One tube held a placebo cream and the other tube held Dermatix (kindly provided by Meda Pharma BV).  Effectiveness on scar quality was evaluated at 1, 3, 6, and 12 months using the Patient and Observer Scar Assessment Scale and the DermaSpectrometer.

Over all visits, the benefit on surface roughness was statistically significant (p = 0.012).   The surface of the topical silicone gel–treated scars showed significantly less roughness (p = 0.014) at 3 months after start of the treatment, and the topical silicone gel–treated scars were significantly less itchy (p = 0.018 and p = 0.013, respectively) at 3 and 6 months.

On average, observers rated scars treated with topical silicone gel slightly better than scars treated with the placebo cream, but repeated measures analysis did not show a significant treatment effect (p = 0.154). The patients rated the scars treated with topical silicone gel and the placebo cream almost equally.

So while topical silicone gel may improve the surface roughness of burn scars and aid in decreasing the itching, it is no better in improving the  overall appearance of the scar than the placebo.  To me this implies or suggests that the simple act of scar massage regardless of the cream/gel used may be the most important in aiding the appearance of the scar.

 

REFERENCES

Topical Silicone Gel versus Placebo in Promoting the Maturation of Burn Scars: A Randomized Controlled Trial; van der Wal, Martijn B. A.; van Zuijlen, Paul P.; van de Ven, Peter; Middelkoop, Esther; Plastic & Reconstructive Surgery. 126(2):524-531, August 2010; doi: 10.1097/PRS.0b013e3181e09559

1 comment:

Cynthia Bailey MD said...

I do find that they are useful for keloid prone individuals. I recommend they apply the products to new wounds, once the skin has healed over, in an effort to try to prevent keloid scar formation. I also recommend them after cortisone injection into a keloid to try to reverse the lesion.

It's good to know that they don't modify burn scars. Thanks for the heads-up from your literature.

Cynthia Bailey MD, Dermatologist