Reducing scars at reduced cost
Accidents, burns and surgery all leave their marks on skin. For years, most people have had little recourse but to suffer these scars or resort to expensive medical procedures to minimize them.
Now they have another option. Several new over-the-counter products promise to make scars look better, at a fraction of the cost of a physician’s treatment.
Dermatologists say these silicone-containing strips, patches, sheets and gels can indeed flatten, smooth and fade raised scars and decrease the itching often associated with them, providing a do-it-yourself, inexpensive alternative to surgical scar removal. But although they certainly won’t hurt, the new products, which tend to run about $15 to $30 a package, probably won’t do anything for older, flat, white scars.
And they require a commitment. Most begin to show results in about eight weeks of continuous use; they may continue to improve the scar for up to a year.
Topical silicone has long been used by plastic surgeons, dermatologists and hospitals to soften, smooth and make less obvious the thickened tissue left behind when the body tries to heal a wound. The new products were developed specifically for so-called hypertrophic, or thickened, scars and for keloid scars, which are ball-shaped protrusions that occur more often among African Americans and Asians than whites. Scars vary from person to person, as well as by age and by location on the body.
Americans have an estimated 840 million scars, of which 169 million are hypertrophic or keloid, and they develop about 62 million new scars each year, according to government statistics.
Among the newest entrants into the “scar therapy” niche are two major brands that can be found in American bathroom cabinets. The maker of Curad bandages, Beiersdorf, last year launched Curad Scar Therapy cosmetic pads, joining a group of existing silicone products that include Cica-Care silicone gel sheets from Smith & Nephew, ReJuveness silicone sheets, Spenco 2nd Skin Scar Therapy pads and gel and ScarEase silicone sheets and gel. And just this month, Johnson & Johnson started shipping Band-Aid Scar Healing Strips to stores nationwide.
Johnson & Johnson’s market research found that women ages 25 to 39 are particularly concerned about scars from caesarean deliveries, breast surgery, minor surgery and trauma, said Marcia Taraschi, director of scientific affairs for the company’s consumer and personal care products.
“Up until now, there really hasn’t been an easy way to go to the store, get something off the shelf and have something that is fairly easy to use,” Taraschi said. The Band-Aid product is a micro-thin sheet of polyurethane with a silicone adhesive that helps provide some support to scar tissue, which typically has about 20% of the strength of regular skin, she said.
Non-silicone alternatives include products like Merz Pharmaceutical’s Mederma Skincare for Scars gel, introduced in this country in 1997, which contains an extract of the onion, Allium cepa, and has posted strong sales growth, according to Shalini Singh, a wound care analyst with the San Jose-based consulting firm Frost & Sullivan. Although some products are touted as containing Vitamin E, the vitamin’s ability to improve healing remains in question because some patients develop irritations, allergies and worsening of their scars. Most of a scar is made up of collagen, a fibrous protein that is less regular, elastic and strong than undamaged skin. When the body tries to repair the area, it creates an overabundance of collagen in the middle layer of skin called the dermis. Usually scars start out reddened because blood vessels proliferate as the body tries to supply the damaged area with blood.
With time, red scars tend to fade, but silicone and other treatments may help speed the process.
Although no one has yet figured out exactly how silicone sheets make a scar look better, some of the effect probably comes from applying gentle pressure to the area, said Dr. Elisabeth Shim, a Santa Monica dermatologic surgeon.
Doctors also theorize that the silicone improves scar healing by keeping the area moister and by keeping it warmer. Higher temperatures are thought to increase the activity of collagenase, an enzyme that breaks down collagen. The silicone itself may also release some compounds into the skin that alter the way fibroblasts in the dermis generate collagen, Shim said.
Overall, the subject of scar healing has been poorly researched, said Shim. Although over-the-counter products can minimize the appearance of scars, they won’t completely eradicate them. They should be used on closed wounds that have at least been covered over by a new, pink layer of skin, but they can also work well on old scars. Shim said there haven’t been good studies comparing the effectiveness of the products on old scars and new scars.
But overall, most doctors believe that though these treatments may help, in-office care is superior, providing better results.
Shim said the first line of treatment for unsightly, hypertrophic or keloid scars often is to inject them with cortisone or alternatively with interferon. Dermatologists and plastic surgeons also treat scars with an anti-cancer drug called 5-fluorouracil and are experimenting with another called Aldara.
Pulse dye lasers or surgical scar revision can also be used, but they’re among the more expensive options.
