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Do scar remedies really work?

Products abound, but doctors say the key is keeping a wound moist and covered.

April 17, 2011|Cathryn Delude | Delude is a special correspondent

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.

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.

For The Record
Los Angeles Times Tuesday, April 19, 2011 Home Edition Main News Part A Page 4 News Desk 1 inches; 24 words Type of Material: Correction
Scars: An April 17 article in Section A on how to treat scars incorrectly identified Los Angeles dermatologist Dr. Jessica Wu as Jennifer Wu.
For The Record
Los Angeles Times Sunday, April 24, 2011 Home Edition Main News Part A Page 4 News Desk 1 inches; 24 words Type of Material: Correction
Scars: An April 17 article in Section A on how to treat scars incorrectly identified Los Angeles dermatologist Dr. Jessica Wu as Jennifer Wu.

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. 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 scars.

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