LA Times - Do scar remedies really work?
atimes.com/health/la-he-scars-20110417,0,4799888.story
FOR THE RECORD
An April 17 article in Section A on how to treat scars referred to Los Angeles dermatologist Dr. Jessica Wu with the incorrect first name of Jennifer.
But not all of those claims stick. "There are a thousand wives' tales and a whole bunch of things you can buy, but none have scientific validity to speak of," says Dr. Terence Davidson, a professor of surgery at UC San Diego School of Medicine.
The remedies are popular, and no wonder: Scars take six months to two years to heal, Davidson adds, and "people want to do something rather than just sit there and watch." Options include onion extract gels, vitamin oils and creams, silicone gels and antibiotic ointments. There are also sticky silicone gel sheets.
Since the products are used for months, any of these approaches can run up a hefty bill not covered by insurance. Mederma, which contains onion extract, costs $30 for a 1.76-ounce tube. A half-ounce of Kelo-cote silicone gel costs $44, and silicone gel sheets start at $25 for small sizes.
But of course, if a scar gets better after months of applying a remedy, it's hard to know whether the treatment or just time made the difference.
Very few well-designed studies have tried to answer that question, says Dr. Joseph Sobanko, a dermatological surgeon at the University of Pennsylvania Health System in Philadelphia. Because everyone heals differently, a good study compares treatments on two similar scars on the same person, such as after breast reduction, or on two halves of the same scar.
Even then, a study may report effectiveness for some esoteric measurement such as elasticity but the treatment may still leave a cosmetically unacceptable scar. "What patients and we physicians care about is whether there's a significant decrease in scar volume and whether it looks better aesthetically," Sobanko says.
The only thing really shown to help the healing process and minimize scarring, he says, is keeping a wound moist and covered. Most scar products do that. But there's little evidence that they work any better than inexpensive petroleum jelly.
A 2009 study in the Journal of the American Academy of Dermatology by Sobanko's colleagues at the University of Pennsylvania found a huge gap between the advertised benefits of over-the-counter scar products and the clinical evidence that they actually work.
For example, Merz Pharmaceuticals, which makes the popular product Mederma, says it is "clinically proven to improve the softness, texture and overall appearance of scars." But there were just two randomized comparison trials of Mederma, with a combined total of 38 participants. Neither trial found that Mederma improved the appearance of scars more than petroleum jelly.
Vitamin E oil didn't fare any better. "If it helps," says Kenneth Arndt, a dermatologist in Newton, Mass., "it's not the E but the oil." He notes that it often causes skin irritation.
Several articles in a March supplement of the Journal of the American Academy of Dermatology show that antibiotic ointments do not aid in healing or reduce the risk of infection — but they do raise the risk of antibiotic resistance.
Silicone gel sheeting seems to be the exception. Several articles reviewing 30 years of research suggest that it can speed healing and lead to thinner, softer, less red and less painful scars, depending on the study. It's not clear what silicone itself does. But the sheets do a better job of keeping the scar covered, and that prevents water from evaporating from the skin.
Moisture is key because it lets the skin grow back evenly, says Dr. Jennifer Wu, a Los Angeles dermatologist. "If you slice a finger open as you're cutting your bagel in the morning, you have two edges of the wound. The new skin grows across that gap," she explains. "If the wound dries, a scab forms between the two edges. Now the skin has to grow down and across, like it encountered a boulder. It's likely to lead to a depressed, pitted scar."
Raised scars, she adds, occur when collagen fibers that usually grow parallel to the surface of the skin grow back in tangled clumps and are no longer smooth. If the growth is too exuberant or poorly organized, the result can be a large scar extending beyond the boundary of the wound. Again, keeping a wound moist helps, according to a 2010 review article in the journal Aesthetic Plastic Surgery, because it reduces production of this excess collagen.
Since the early 1980s, when silicone gel sheets were introduced for burn victims, numerous small studies have shown that the sheets reduce the risk of developing scars. They can also soften and increase the elasticity of existing ones — but it's unclear how they do so.
The problem is that these sheets are uncomfortable and hard to apply to contoured areas, and many people won't wear them on their faces, says Dr. Thomas Mustoe, a plastic surgeon at Northwestern University's Feinberg School of Medicine in Chicago. Silicone gel is easier to use, and it dries clear on the skin so it doesn't rub off like ointments. It can even be worn under makeup. "It's not as well studied, but it's increasingly recognized that silicone gel can help too," Mustoe says. "It has a moderate effect. It's not dramatic."
For large raised scars, the recommendation from a 2002 expert panel report is to inject them with corticosteroids. "Scars get red, swollen and itchy because of inflammation, and corticosteroids are anti-inflammatory. They break down scar tissue to soften bumpy scars," Wu says. Patients may need monthly shots, at $100 to $200 per office visit. Most insurance companies do not cover these, despite the pain and immobility that difficult scars cause.
Arndt, the dermatologist in Massachusetts, says several newer treatments for very difficult scars are becoming more widespread. These include injections of the chemotherapy agent 5-flourouracil, which interferes with cell growth in the scar tissue. Lasers can reduce raised scars and minimize redness, at about $500 per treatment.
When all else fails, plastic surgeons can perform scar revision, cutting out a raised scar and carefully suturing the skin without tension — a tricky business that doesn't always work in people prone to developing large scars.
[email protected]
Delude is a special correspondent.
latimes.com
Scar remedies' effectiveness not so clear
Products for erasing old scars or preventing new ones abound, but few studies address whether they really work. The key to minimizing scarring, doctors say, is keeping a wound moist and covered.
By Cathryn Delude, Los Angeles Times
8:53 AM PDT, April 17, 2011
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Time may heal all wounds, but the scars that remain can be unsightly, itchy, stiff and painful. Pharmacy aisles beckon with "clinically proven, doctor-recommended" scar products, and the Internet teems with anecdotes of different creams and elixirs that supposedly erase old scars or prevent new ones from forming.
FOR THE RECORD
An April 17 article in Section A on how to treat scars referred to Los Angeles dermatologist Dr. Jessica Wu with the incorrect first name of Jennifer.
But not all of those claims stick. "There are a thousand wives' tales and a whole bunch of things you can buy, but none have scientific validity to speak of," says Dr. Terence Davidson, a professor of surgery at UC San Diego School of Medicine.
The remedies are popular, and no wonder: Scars take six months to two years to heal, Davidson adds, and "people want to do something rather than just sit there and watch." Options include onion extract gels, vitamin oils and creams, silicone gels and antibiotic ointments. There are also sticky silicone gel sheets.
Since the products are used for months, any of these approaches can run up a hefty bill not covered by insurance. Mederma, which contains onion extract, costs $30 for a 1.76-ounce tube. A half-ounce of Kelo-cote silicone gel costs $44, and silicone gel sheets start at $25 for small sizes.
But of course, if a scar gets better after months of applying a remedy, it's hard to know whether the treatment or just time made the difference.
Very few well-designed studies have tried to answer that question, says Dr. Joseph Sobanko, a dermatological surgeon at the University of Pennsylvania Health System in Philadelphia. Because everyone heals differently, a good study compares treatments on two similar scars on the same person, such as after breast reduction, or on two halves of the same scar.
Even then, a study may report effectiveness for some esoteric measurement such as elasticity but the treatment may still leave a cosmetically unacceptable scar. "What patients and we physicians care about is whether there's a significant decrease in scar volume and whether it looks better aesthetically," Sobanko says.
The only thing really shown to help the healing process and minimize scarring, he says, is keeping a wound moist and covered. Most scar products do that. But there's little evidence that they work any better than inexpensive petroleum jelly.
A 2009 study in the Journal of the American Academy of Dermatology by Sobanko's colleagues at the University of Pennsylvania found a huge gap between the advertised benefits of over-the-counter scar products and the clinical evidence that they actually work.
For example, Merz Pharmaceuticals, which makes the popular product Mederma, says it is "clinically proven to improve the softness, texture and overall appearance of scars." But there were just two randomized comparison trials of Mederma, with a combined total of 38 participants. Neither trial found that Mederma improved the appearance of scars more than petroleum jelly.
Vitamin E oil didn't fare any better. "If it helps," says Kenneth Arndt, a dermatologist in Newton, Mass., "it's not the E but the oil." He notes that it often causes skin irritation.
Several articles in a March supplement of the Journal of the American Academy of Dermatology show that antibiotic ointments do not aid in healing or reduce the risk of infection — but they do raise the risk of antibiotic resistance.
Silicone gel sheeting seems to be the exception. Several articles reviewing 30 years of research suggest that it can speed healing and lead to thinner, softer, less red and less painful scars, depending on the study. It's not clear what silicone itself does. But the sheets do a better job of keeping the scar covered, and that prevents water from evaporating from the skin.
Moisture is key because it lets the skin grow back evenly, says Dr. Jennifer Wu, a Los Angeles dermatologist. "If you slice a finger open as you're cutting your bagel in the morning, you have two edges of the wound. The new skin grows across that gap," she explains. "If the wound dries, a scab forms between the two edges. Now the skin has to grow down and across, like it encountered a boulder. It's likely to lead to a depressed, pitted scar."
Raised scars, she adds, occur when collagen fibers that usually grow parallel to the surface of the skin grow back in tangled clumps and are no longer smooth. If the growth is too exuberant or poorly organized, the result can be a large scar extending beyond the boundary of the wound. Again, keeping a wound moist helps, according to a 2010 review article in the journal Aesthetic Plastic Surgery, because it reduces production of this excess collagen.
Since the early 1980s, when silicone gel sheets were introduced for burn victims, numerous small studies have shown that the sheets reduce the risk of developing scars. They can also soften and increase the elasticity of existing ones — but it's unclear how they do so.
The problem is that these sheets are uncomfortable and hard to apply to contoured areas, and many people won't wear them on their faces, says Dr. Thomas Mustoe, a plastic surgeon at Northwestern University's Feinberg School of Medicine in Chicago. Silicone gel is easier to use, and it dries clear on the skin so it doesn't rub off like ointments. It can even be worn under makeup. "It's not as well studied, but it's increasingly recognized that silicone gel can help too," Mustoe says. "It has a moderate effect. It's not dramatic."
For large raised scars, the recommendation from a 2002 expert panel report is to inject them with corticosteroids. "Scars get red, swollen and itchy because of inflammation, and corticosteroids are anti-inflammatory. They break down scar tissue to soften bumpy scars," Wu says. Patients may need monthly shots, at $100 to $200 per office visit. Most insurance companies do not cover these, despite the pain and immobility that difficult scars cause.
Arndt, the dermatologist in Massachusetts, says several newer treatments for very difficult scars are becoming more widespread. These include injections of the chemotherapy agent 5-flourouracil, which interferes with cell growth in the scar tissue. Lasers can reduce raised scars and minimize redness, at about $500 per treatment.
When all else fails, plastic surgeons can perform scar revision, cutting out a raised scar and carefully suturing the skin without tension — a tricky business that doesn't always work in people prone to developing large scars.
[email protected]
Delude is a special correspondent.
Copyright © 2011, Los Angeles Times
Start weight (7/08): 270
Surgery date (11/18/09): 244
Current: 150
Surgery date (11/18/09): 244
Current: 150
Interesting study. I'm sure the creators of scar-treatments try to promote their effectiveness with inconclusiveness statistics- better profit for them. My scars healed really well from my bypass, arm lift, and tummy tuck- my arms are barely visible and cannt be noticed unless it's from like 2 inches away. I did use vitamin E oil occasionally but I also used the gel strips on them for a short period of time. I don't know if they helped at all though. I didn't use any scar treatment on my tummy tuck scar and it's faded significantly although not as much as my arms did. Usually you can't even notice scars after about a year and if they aren't completely invisible, they're not even that bad and no big deal. Bunched up wrinkly folds of skin or bat wings are more obvious and harder to cover up. I used to wear jackets in the summertime even in 90 degree east coast weather to hide my belly and arms, even after I lose weight. After the plastics I could care less about my scars cuz being able to wear short sleeves and form fitting clothes without body shapers outweighs scars by far! :) I really hope to have my thighs done soon so I can add wearing shorts to that list!
Believe it or not:
No scar sheets or special creams
1700 calories a day while healing
No compression wear, no girdles, no garments
I do have rather thick scarring at my elbows because they are always in motion, but my arms wer profoundly large. Scar sheets wouldn't have stayed on.
Otherwise, you'd have to look really hard to find most of my scars. Answer for me was keeping hydrated, keeping wounds dry after bathing, letting them heal completely under bandages, a little sal****er and chlorine in time, getting infusions when my iron tanked post-op, and oxygenating the system as soon as I could by exercise-- even short walks.
"Oh sweet and sour Jesus, that is GOOD!" - Stephen Colbert Lap RNY 7/07-- Lap Gallbladder 5/08--
Emergency Bowel Repair 6/08 -Dr. Meilahn, Temple U. Upper and Lower Bleph/Lower Face Lift 12/08
Fraxel Repair 2/09-- Lower Bleph Re-Do 5/09 -Dr. Pontell, Media PA Mastopexy/Massive
Brachioplasty/ Extended Abdominoplasty (plus Mons Lift and Upper Leg lift) / Hernia Repair
6/24/09 ---Butt Lift and Lateral Thighplasty Scheduled 7/6/10 - Dr. Ivor Kaplan VA Beach
Total Cost: $33,500 Start wt: 368 RNY wt: 300 Goal wt: 150 Current wt: 148.2 BMI: 24.7
Damn your hotttt. I'm off to the treadmill asap dang your result are sick
. I can hope and pray for such great sucess. 
My first surgery was an arm lift - I used ever scar treatment available and spent alot of money. That was 18 months ago. A few months later I had a tummy tuck and used no scar treatment. Today the scars are my arms (mostly think white line) look no different than the scars from the tummy tuck. I've had seven procedures since then and the only thing I've used is vaseline and everything is healing just fine.
My PS des not recommend the use of anything for scars. short of normal lotions one would use in their daily routine anyway.. he said they are a waste of money and you skin will heal in time... and he said never vitamin e oil...it has been shown to increase scarring... (he said lotion with vit e is ok but not pure oil)
I'd really hate to buy and use a bunch of stuff that didn't really help. I like the idea of just using Vaseline, since it seems to be widely accepted by doctors that it does all we really need. The marketing of these products is so engrained, it becomes hard to be objective after awhile.
Start weight (7/08): 270
Surgery date (11/18/09): 244
Current: 150
Surgery date (11/18/09): 244
Current: 150
For those interested, the single most cost-effective treatment for incision scar treatment I've found is a soft silicone tape called Mepitac. It's non-sticky but adheres great and is super non irritating. Best of all it's really cheap compared to traditional silicone sheeting
a 3 meter roll (almost 9 feet long) can be picked up for $13.
http://www.healthykin.com/showproduct.aspx?ProductID=2988&SE Name=molnlycke-mepitac-soft-silicone-tape
This tape is great for arm lift and thigh lift incisions. It can be removed and will restick to bath or shower.
a 3 meter roll (almost 9 feet long) can be picked up for $13.
http://www.healthykin.com/showproduct.aspx?ProductID=2988&SE Name=molnlycke-mepitac-soft-silicone-tape
This tape is great for arm lift and thigh lift incisions. It can be removed and will restick to bath or shower.
on the web at Plastic Surgery Specialists
blogging on all things plastic surgery at Plastic Surgery 101
blogging on all things plastic surgery at Plastic Surgery 101
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