SkinTECH

Clinical studies with silicone scar sheets

 

 

 

Topical Silicone Gel: A New Treatment for Hypertrophic Scars

 

Ahn ST, Monafo W, Mustoe TA

Surgery 1989 Oct, 106 4:781-786

 

“the treated scars were improved significantly at 4, 8, and 12 weeks, compared with both their own treatment value and the control scars”

“We conclude that this simple method of treating hypertrophic scar is efficacious, even in relatively chronic cases.”

 

 

Silicone gel sheets relieve pain and pruritus with clinical improvement of keloid: possible target of mast cells.

 

Eishi K, Bae SJ, Ogawa F, Hamasaki Y, Shimizu K, and Katayama I . The Journal of dermatological treatment 2003; 14(4):248-52.

 

“Silicone gel sheet treatment is widely used to treat hypertrophic scars and keloids since it is easily applied and prevents scar pain and itching.”

The pain and itching clearly decreased after 4 weeks of the silicone gel sheeting and disappeared after 12 weeks.  Twelve weeks were required for a reduction in scar redness and elevation.

“Silicone gel sheeting is effective and safe, especially with more severe symptoms of pain and itching possibly induced by mediators derived from increased mast cells.”

 

FULL paragraph

Silicone gel sheet treatment is widely used to treat hypertrophic scars and keloids since it is easily applied and prevents scar pain and itching. We used Cica-Care silicone gel sheets in the conservative treatment of six patients for 24 weeks and recorded pain, itching, redness, and scar elevation every 4 weeks. We also investigated the number of mast cells and Fas antigen expression in the lesional skin (one patient) before and after treatment. The pain and itching clearly decreased after 4 weeks of the silicone gel sheeting and disappeared after 12 weeks. Twelve weeks were required for a reduction in scar redness and elevation. After 24 weeks, a decrease in the number of mast cells and the enhanced expression of Fas antigen by lesional fibroblasts were observed. Thus, silicone gel sheeting is effective and safe, especially with more severe symptoms of pain and itching possibly induced by mediators derived from increased mast cells.

 

 

Silicone thermoplastic sheeting for treatment of facial scars: an improved technique.

 

Bradford BA, Breault LG, Schneid T, and Englemeier RL. 

Journal of Prosthodontics 1999 ;8(2):138-41

 

“Silicone thermoplastic sheeting has been used successfully in the management of hypertrophic and keloid scars resulting from thermal burn injuries”

 

 

International clinical recommendations on scar management. 

 

Mustoe TA, Cooter RD, Gold MH, et al. Plast Reconstr Surg. 2002;110:560–571

 

“Preventative recommendations included meticulous surgical technique, hypoallergenic taping, and silicone gel sheeting. Non-surgical scar treatments include triamcinolone injections, cryotherapy, silicone gel sheeting, pressure sheeting, and radiation therapy.”

 

 

The effect of silicone gel sheets on perfusion of hypertrophic burn scars.

 

Musgrave MA, Umraw N, Fish JS, Gomez M, Cartotto RC. J Burn Care Rehabil. 2002 May-Jun;23(3):208-14.

 

http://www.ncbi.nlm.nih.gov/sites/entrez

 

 

Silicone sheeting decreases fibroblast activity and downregulates TGFbeta2 in hypertrophic scar model.

 

Kuhn MA, Moffit MR, Smith PD, Lyle WG, Ko F, Meltzer DD, Robson MC. Int J Surg Investig. 2001;2(6):467-74.

 

BACKGROUND: Fibroproliferative disorders, which include hypertrophic scars and keloids, represent deviations from the normal process of wound healing. The fibrogenic cytokines have been associated with excessive scarring. It has been proposed that placing silicone in contact with hypertrophic scars may prove to be an effective form of treatment. This may be a result of downregulating fibroblasts and/or decreasing the fibrogenic cytokines. An in vitro model to study wound contraction is a fibroblast populated collagen lattice (FPCL). This study used FPCL as a method to study the effect of silicone sheeting on hypertrophic scar fibroblasts.

 

METHODS: Fibroblast cultures were obtained and collagen lattices were prepared. Silicone sheeting was placed over the collagen matrix versus Saran wrap used as a treatment control. The amount of gel contraction was measured every 24 hours for five days. The supernatant obtained from the culture medium following completion of the FPCL portion of the experiment was then used in an immunoassay for TGFbeta2.

 

RESULTS: A statistically significant decrease in amount of FPCL contraction occurred between three of the four brands of silicone sheets used compared to untreated control or Saran wrap treated FPCL. The immunoassay for TGFbeta2 showed a statistically significant decrease with all four types of silicone sheeting. 

 

CONCLUSION: FPCLs populated with burn hypertrophic scar fibroblasts exposed to silicone sheeting have decreased contraction compared to an unexposed control and Saran wrap treated control. In addition, TGFbeta2 is downregulated in the silicone exposed group. It appears that silicone sheeting may act by downregulating fibroblasts and decreasing fibrogenic cytokines.

 

 

The role of the epidermis in the control of scarring: evidence for mechanism of action for silicone gel.

 

Tandara AA, Mustoe TA. J Plastic Reconstructive and Aesthetic Surgury. 2008 Oct;61(10):1219-25

 

Hypertrophic scars can be reduced by the application of silicone dressing; however, the detailed mechanism of silicone action is still unknown. It is known that silicone gel sheets cause a hydration of the epidermal layer of the skin. An in vitro co-culture experiment has shown that hydration of keratinocytes has a suppressive effect on the metabolism of the underlying fibroblasts resulting in reduced collagen deposition. We tested the hypothesis that silicone sheeting in vivo has a beneficial effect on scarring by reducing keratinocyte stimulation, with a resulting decrease in dermal thickness, hence scar hypertrophy. Silicone adhesive gel sheets were applied to scars in our rabbit ear model of hypertrophic scarring 14 days post wounding for a total of 16 days. Scarring was measured in this model by the scar elevation index (SEI), a ratio of the area of newly formed dermis to the area of the dermis of unwounded skin, and the epidermal thickness index (ETI), a ratio of the averaged epidermal height of the scar to the epidermal thickness of normal epidermis. Specific staining [anti-PCNA (proliferating cell nuclear antigen) and Masson trichrome] was performed to reveal differences in scar morphology. SEIs were significantly reduced after silicone gel sheet application versus untreated scars corresponding to a 70% reduction in scar hypertrophy. Total occlusion reduced scar hypertrophy by 80% compared to semi-occlusion. ETIs of untreated scars were increased by more than 100% compared to uninjured skin. Silicone gel treatment significantly reduced epidermal thickness by more than 30%. Our findings demonstrate that 2 weeks of silicone gel application at a very early onset of scarring reduces dermal and epidermal thickness which appears to be due to a reduction in keratinocyte stimulation. Oxygen can be ruled out as a mechanism of action of silicone occlusive treatment. Hydration of the keratinocytes seems to be the key stimulus.

 

 

 

A Review of the Biologic Effects, Clinical Efficacy, and Safety of Silicone Elastomer Sheeting for Hypertrophic and Keloid Scar Treatment and Management

 

 

Effectiveness of Silastic Sheet Coverage in the Treatment of a Keloid Scar: 

Ohmori S. Aesthetic Plastic Surgery 1988 ; 12: 95-99

 

http://www.ncbi.nlm.nih.gov/sites/entrez

 

 

Silicone Gel Scar Treatment Quinn KJ / Controlled Therapeutics (Scotland) Ltd, East Kilbridge

Burns, Including Thermal Injury (England) Oct 1987, 13 Suppl S323-40

 

Topical Silicone Gel Sheeting in the Treatment of Hypertrophic Scars and Keloids:

A Dermatological Experience Gold MH / Journal of Dermatology - Surgical Oncology 1993; 19:912-916

Exerpts

“The silicone gel sheets resulted in moderate improvement in scar thickness, scar color and was noted to be effective to some degree in all tested. The material was easy to use and painless.”

CONCLUSION. Topical silicone gel sheeting is an effective method for the treatment of hypertrophic and keloid scars and may be considered useful in the treatment of these difficult cutaneous lesions.

 

Treatment of Hypertrophic and Keloid Scars with Silastic Gel Sheeting

 

Dockery GL, Nilson RZ

Journal of Foot and Ankle Surgery 1994 Mar-Apr; 33 2:110

EXERPT:

 

“Overall, the success rate (somewhat improved to greatly improved) for the treatment of hypertrophic and keloid scars is high (95%).”

 

Skin Disorders in Black Children 

Laude TA ;Current Opinion Pediatrics, 1996 Aug 8 4: 381-385

 

“Keloids and hypertrophic scars in children are effectively treated with silicone gel sheeting.”

http://www.ncbi.nlm.nih.gov/pubmed/8954271

 

Silicone Gel in the Treatment of Keloids

Murdoch GE, Salisbury JA, Gibson JR

ACTA Derm. Venereal 1990, 70/2 (181-183)

 

The Use of Silicone Gel in the Control of Hypertrophic Scarring

McNee J / Physiotherapy 1990, 76/4 (194-197)

http://www.ncbi.nlm.nih.gov/pubmed/16437463

 

Hypertrophic Sternal Scars: Silicone Gel Sheet versus Kenalog Injection Treatment 

Sproat, JE, Dalcin A, Weitauer N, Roberts RS 

Plastic and Reconstructive Surgery, 1991 90: 988-992

“This study demonstrates that silicone gel sheets provide earlier symptomatic relief and a more aesthetic scar and are the preferred treatment of patients with symptomatic hypertrophic sternal scars.”

http://www.ncbi.nlm.nih.gov/sites/entrez

 

Silicone Occlusive Sheeting (SOS) in the Management of Hypertrophic Scarring, Including the Possible Mode of Action of Silicone

Hirshowitz B, et al (1993)

European Journal of Plastic Surgery, 16: 5-9

 

Silicone Gel: a New Treatment for Burn Scars and Contractures

Perkins K, Davey RB, Wallis KA

Burns 1982; p 201-204

 

Treating Hypertrophic Scars with Silicone Gel. A Preliminary Report of a Trial of Silastic Gel in the Treatment of Patients with Hypertrophic Burn Scars

Carney SA, Cason CG, Gowas JP

Journal of Wound Care 1993; 2:197-198

 

Evidence That Use of a Silicone Sheet Increases Range of Motion Over Burn Wound Contracutres

Wessling N, Ehleben CM, Chapman V, May SR, Still JM

Journal of Burn Care and Rehabilitation 1985/6, p503-5

 

Non-pressure Treatment of Hypertrophic Scars

Quinn KJ, Evans JH, Courtney JM, Gaylor JDS, Reid WH

Burns 1985; 102-108

 

“A silicone gel (Dow Corning X7-9119) has been successfully used in the management of hypertrophic scars. The gel softens and reduces scars in a shorter time period than pressure therapy.”

 

Oncologic Applications for Silicone Gel Sheets in Soft Tissue Contractures

Burkhardt A, Weitz J

American Journal of Occupational Therapy, May 1991, 45: 460-2

 

Effects of silicone gel on burn scars.

Momeni M, Hafezi F, Rahbar H, Karimi H. Burns. 2009 Feb;35(1):70-4

“CONCLUSION: Silicone gel is an effective treatment for hypertrophic burn scars.”

 

Silicone Gel in the Treatment of Keloid Scars

Mercer NSG / British Journal of Plastic Surgery 1989, 42: 83-87

 

 

Topical Treatments for Hypertrophic Scars 

Zurada AB, Kriegel D, Davis I, Journal of the American Academy of Dermatology December 2006: 55: 6 

 

 

Sense and Nonsense of Scar Creams and Gels 

Van den helder CJM, Hage JJ 

Anesth Plastic Surgery 1994; 18: 307-313

 

 

Keloid and hypertrophic scars

Tønseth KA, Tindholdt TT, Solberg US, Busic V, Mesic H, Begic A. Tidsskr Nor Laegeforen. 2003 Nov 6;123(21):3033-5

 

“Patients who are at high-risk or show excessive scar development should follow standard treatment. First-line therapy is silicone sheeting…”

 

 

Incidence of hypertrophic scars among African Americans linked to vitamin D-3 metabolism? 

Cooke GL, Chien A, Brodsky A, Lee RC. J Natl Med Assoc. 2005 Jul;97(7):1004-9.

 

The pathogenesis and progression of wound-healing involve intricate pathways and numerous chemical mediators. This remains an area of intense study as undesirable results of this process, such as hypertrophic scars and keloids, can result in significant morbidity. These lesions are distinct in their characteristics, although they are similar in their distribution in patients with darker skin colors. There is a robust inflammatory mechanism behind the formation of hypertrophic scars and keloids. Furthermore, their development may be intimately related to vitamin D-3, which has been shown to be a powerful anti-inflammatory agent. This chemical is made in the skin, whose production is influenced by various factors of which the amount of melanin is a crucial one. More specifically, an increase in pigmentation has been shown to decrease the amount of vitamin D-3 synthesis in the skin. Thus, this paper proposes the hypothesis linking the propensity of inflammation and subsequent scarring in darker-skinned individuals to the reduced levels of vitamin D-3 production in their skin.