Non Surgical Treatments for Keloid Scars

The application of mechanical pressure by compression devices is advocated in the treatment of keloid scars. Pressure may theoretically break up collagen bundles and soften the keloid mass; however, therapy must be instituted for long periods (>23 h/d for 6 mo) before significant effect can be achieved. Unfortunately, many regions of the head and neck are not amenable to pressure application. Silicone sheeting is used to decrease the irritation and pruritus associated with keloids. The proposed mechanism of action involves maintenance of scar hydration and inducement of a subsequent decrease in cytokine release, resulting in less collagen deposition. Certain authors report great success in keloid regression with this modality. Unfortunately, the general opinion on silicone sheeting does not support significant reduction in the dimensions or pigment characteristics of keloids, although silicone sheeting can be very effective in decreasing pruritus.

Various therapies, including nitrogen mustard, tetroquinone, antihistamines, retinoic acids, zinc, vitamin A, vitamin E, and verapamil, have been used with varying degrees of success.

Interferon (IFN) therapy is used because of its ability to reduce collagen synthesis in dermal fibroblasts. Granstein et al. reported a 30% reduction in keloid height after intralesional injections of IFN-gamma 3 times weekly for 3 weeks. As with other treatment modalities, some recurrences are to be expected. IFN has adverse effects, including low-grade fevers, a flulike illness for 48-72 hours after injection, and pain on injection.

>>>Combined modality: keloids removal

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Silicon gel sheeting for preventing and treating hypertrophic and keloid scars.
O'Brien L, Pandit A.
Alfred Hospital, Occupational Therapy, PO Box 315, Prahran, Victoria, Australia, 3181. l.obrien@alfred.org.au

BACKGROUND: Keloid and hypertrophic scars are common and are caused by a proliferation of dermal tissue following skin injury. They cause functional and psychological problems for patients, and their management can be difficult. The use of silicon gel sheeting to prevent and treat hypertrophic scarring is still relatively new, and started in 1981 with treatment of burn scars. OBJECTIVES: To determine the effectiveness of silicon gel sheeting for: (1) prevention of hypertrophic or keloid scarring in people with newly healed wounds (e.g. post surgery); (2) treatment of established scarring in people with existing keloid or hypertrophic scars. SEARCH STRATEGY: Trials were identified from searches of the Cochrane Wounds Group Specialised Register (searched September 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2005); MEDLINE (1989 to June 2002); EMBASE (1988 to May 2002); CINAHL (1982 to May 2002) and reference lists of articles and relevant reviews. The major supplier of silicon gel sheeting (Smith and Nephew) was approached for details of unpublished, ongoing and recently published trials. SELECTION CRITERIA: Any randomised or quasi-randomised controlled trials, or controlled clinical trials comparing silicon gel sheeting for prevention or treatment of hypertrophic or keloid scars against no treatment, placebo, or any other treatment type except surgery. DATA COLLECTION AND ANALYSIS: All relevant trials were assessed for methodological quality. Data were extracted independently by both reviewers using a standardized form, and the results cross-checked. All trials, meeting the selection criteria were assessed for methodological quality. MAIN RESULTS: Thirteen trials, involving 559 people, ranging in age from 2 to 81 years, were included in the review. The trials compared adhesive silicon gel sheeting with control; non-silicon gel sheeting; silicon gel plates with added Vitamin E; laser therapy; triamcinolone acetonide injection, and non-adhesive silicon gel sheeting. In the prevention studies, when compared with a no treatment option; whilst silicon gel sheeting reduced the incidence of hypertrophic scarring in people prone to scarring, (RR 0.46, 95% CI 0.21 to 0.98) these studies were highly susceptible to bias. Silicon gel sheeting produced a statistically significant improvement in scar elasticity, (RR 8.60, 95% CI 2.55 to 29.02), but again these studies were highly susceptible to bias. AUTHORS' CONCLUSIONS: Trials evaluating silicon gel sheeting as a treatment for hypertrophic and keloid scarring are of poor quality and highly susceptible to bias. There is weak evidence of a benefit of silicon gel sheeting as a prevention for abnormal scarring in high risk individuals but the poor quality of research means a great deal of uncertainty prevails.

Ann Ital Chir. 2005 Jan-Feb;76(1):79-83. Related Articles, Links
[Silicone occlusive sheeting vs silicone cushion for the treatment of hypertrophic and keloid scars. A prospective-randomized study]
[Article in Italian]
Amicucci G, Schietroma M, Rossi M, Mazzotta C.
Dipartimento di Scienze Chirurgiche Universita degli Studi di L'Aquila.

BACKGROUND: Silicone gel and silicone occlusive sheeting are widely used at present for the treatment of hypertrophic and keloid scars. In recent studies the possibility was raised that static electricity generated by friction activated silicone sheeting could be the reason for this effect, and that it can, with time, cause involution of hypertrophic and keloid scars. Objective of this study was to test this hypothesis and to observe weather a continuous and also an increased negatively charged static electric field will shorten the treatment period. A silicone cushion was developed with the purpose of increasing a negative static-electric charge to accelerate the regression process. METHODS: From November 2001 to June 2002 we studied in a prospective randomized study, 72 patients with hypertrophic an keloid scars. The trial extended over a 8-month period. 37 patients underwent silicone occlusive sheeting, the remaining 35 patients underwent silicone cushion (Clinicel). RESULTS: Treatment with the silicone cushions yielded 74,2% cessation of itching and burning followed by pallor and flattening of the scar, some markedly so, over a few weeks to 5 months period. Additional 25,7% had their scars resolved in up to 8 months of treatment. Four patients (11,4%) who add recalcitrant scars with little response to the use of the silicone cushion were given intralesional corticosteroid injections, in addiction to the use of the cushion, resulting in a fairly rayed resolution of these scars over a period of 2 months. Treatment with the silicone occlusive sheeting yielded 52,3% itching and burning cessation followed by pallor and flattening of the scar, some markedly so, over a few weeks to 5 months period. Additional 22,1% had their scars resolved in up to 8 months of treatment. In conclusion by comparing the results of this trial using silicone cushions for the treatment of hypertrophic and keloid scars with those obtained using silicone gel or occlusive sheeting, a much faster response was demonstrated.

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Dissolves scar tissues and releases the aminoacids and other components in them for the reproduction of fibroblasts which give rise to new connective tissues and glycosaminoglycans -the molecules that deeply moisturize, firm skin and give it strenght and capacity to withstand over-stretching. It also replenishes the lipid barrier of the skin and triggers the regeneration of damaged cells while preventing and removing acne scars, keratosis, psoriasis scales and all types of skin blemishes.

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