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Journal of Cutaneous and Aesthetic Surgery - Jul-Dec 2009, Volume 2, Issue 2
104
Neerja Puri, Ashutosh Talwar
Department of Dermatology, Guru Gobind Singh Medical College, Faridkot, Punjab, India
DOI: 10.4103/0974-2077.58527
Address for correspondence:
Dr. Neerja Puri, C/O Dr. Asha Puri, House No. 626, Urban Estate, Dugri Road, Ludhiana, Punjab, India. E-mail: neerjaashu@rediffmail.com
short CoMMuniCation
introDuction
Scars vary greatly in quality, depending on individual
and racial patient features, the nature of the trauma,
and the conditions of wound healing.[1] They frequently
determine aesthetic impairment and may be symptomatic,
causing itching, tenderness, pain, sleep disturbance,
anxiety, depression and disruption of daily activities.
Other psychological sequelae include posttraumatic
stress reactions, loss of self esteem and stigmatization
leading to a diminished quality of life. Scar contractures
also can determine disabling physical deformities.[2-5] All
these problems are more troublesome to the individual
patient, particularly when the scar cannot be hidden
by clothes. This study was undertaken to verify the
efcacy of a new topical silicone treatment; a self-drying
spreadable gel that needs no means of xation and
cannot be seen because of complete transparency.
Silicone gel contains long chain silicone polymer
(polysiloxanes), silicone dioxide and volatile component.
Long chain silicone polymers cross link with silicone
dioxide. It spreads as an ultra thin sheet and works
24 hours per day.[6,7] It has a self drying technology and
itself dries within 4-5 minutes. It has been reported to be
effective and produce 86% reduction in texture, 84% in
color and 68% in height of scars.[8,9] Silicon gel exerts
several actions which may explain this benet in scars:
a) It increases hydration of stratum corneum
and thereby facilitates regulation of fibroblast
production and reduction in collagen production.
It results into softer and atter scar. It allows skin
to “breathe”.
b) It protects the scarred tissue from bacterial invasion
and prevents bacteria- induced excessive collagen
production in the scar tissue.
c) It modulates the expression of growth factors,
broblast growth factor β (FGF β) and tumor growth
factor β (TGF β). TGF β stimulates fibroblasts
to synthesize collagen and fibronectin. FGF β
normalizes the collagen synthesis in an abnormal
scar and increases the level of collagenases which
breaks down the excess collagen. Balance of
brogenesis and brolysis is ultimately restored.
d) Silicone gel reduces itching and discomfort
associated with scars.
The advantages of silicon gel include easy administration,
even for sensitive skin and in children. It can be applied
for any irregular skin or scar surfaces, the face, moving
parts (joints and exures) and any size of scars. A tube of
15 gram contains enough silicone gel to treat 3-4 inches
(7.5-10 cm) scar twice a day for over 90 days.
materials anD methoDs
The study enrolled 30 patients having scars. Written
informed consent was taken from all the patients before
the study. Also, prior approval of hospital ethical
committee was taken before the study. The silicone gel
was applied as a thin lm twice a day. It was rubbed with
ngertips for 2-3 minutes. For fresh scars, treatment was
started just days after wound closure or after 5-10 days.
The scars were evaluated at monthly intervals. The
Topical self drying silicone gel is a relatively recent treatment modality promoted as an alternative to topical silicone
gel sheeting. Thirty patients with scars of different types including superficial scars, hypertrophic scars, and keloids
were treated with silicon gel application. The results of the self-drying silicone gel have been satisfactory.
keyWorDs: Keloids, scars, silicone
The Efficacy of Silicone Gel for the Treatment of Hypertrophic
Scars and Keloids
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Journal of Cutaneous and Aesthetic Surgery - Jul-Dec 2009, Volume 2, Issue 2 105
Puri and Talwar: Silicone gel for scars
appearance of scar, including scar type, scar size and
scar color was assessed by the physician. We classied
hypertrophic scar as a red or dark pink, raised (elevated)
sometimes itchy scar conned within the border of the
original surgical incision, with spontaneous regression
after several months and a generally poor final
appearance. A keloid is instead classied as a scar red to
brown in colour, very elevated, larger than the wound
margins very hard and sometimes painful or pruritic
with no spontaneous regression.
Patients were observed and the results were compared
at monthly follow up examinations. Follow up was done
for 6 months. All scars were measured and photographed
before treatment onset. Scars were graded 1 to 4 on the
basis of criteria in Table 1. Final photographs were taken
at this time.
results
Eleven cases (36.66%) were in the age groups of 30-
40 years, 8 (26.66%) cases between 20-30 years, 5 (16.66%)
cases between 40-50 years, 2 (6.610%) cases between 10-
20 years and 50- 60 years of age each and 1 (3.33%) case
of . 60 years of age and between 5 and 10 years of age
each. Male:Female ratio was 2:1. It was also seen that
most (40%) of the scars were between 1 and 3 months
duration, 26.6% of scars were of less than 1 month
duration, 20% of scars were between 3 and 6 months
and 13.33% scars were of more than 6 months duration.
The commonest type of scars were hypertrophic scars
(Grade III, 50%) followed by mildly hypertrophic scars
(Grade II, 26.6%) and keloids (Grade IV, 23.33%). Most of
the scars were between 1 and 3 months duration (40%),
26.6% of scars were of less than 1 month duration, 20%
of scars were between 3 and 6 months and 13.33% scars
were of more than 6 months duration,
After treatment, improvement was noted in the scars
[Figures 1-3]. Sixty percent scars were graded as normal
(Grade I), while 20% were graded as mildly hypertrophic
(Grade II). Twenty percent of scars were of Grade III and
IV at the end of study;10% in each grade [Table 2]. Side
effects were few. Allergic reaction to silicone gel was seen
in one case and mild desquamation was seen in 2 cases.
Discussion
Since the early 1980s, silicone gel sheeting has been widely
used in the treatment of hypertrophic scars and keloids.
Several clinical studies and reviews have conrmed its
efcacy.[10,11]
While many treatments have been suggested in the past
for scars, only a few of them have been supported by
prospective studies with adequate control group. Only
Table 2: Grading of scars after treatment
Grading Number of cases Percentage
I (Normal) 18 60
II (Mildly hypertrophic) 6 20
III (Hypertrophic) 3 10
IV (Keloid) 3 10
Figure 1: A patient with hypertrophic scar before and after
treatment
Figure 2: A patient with burn scar before and after treatment
Figure 3: A patient with minor keloid before and after
treatment
Table 1: Classification of scars according to morphologic
features
Grade
I (Normal) Flat, soft, normal color
II (Mildly hypertrophic) Slightly elevated, moderately hard, light
to dark pink color
III (Hypertrophic) Elevated (within wound margins) hard,
dark pink to dark red color
IV (Keloid) Very elevated, larger than wound
margins, very hard, red to brown color
two treatments can be said to have sufcient evidence
for scar management; topical application of silicone gel
sheeting and the intralesional injection of corticosteroids.
[12]
The former generally is indicated as both a preventive and
the therapeutic device, the latter as a therapeutic agent
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Journal of Cutaneous and Aesthetic Surgery - Jul-Dec 2009, Volume 2, Issue 2
106
Puri and Talwar: Silicone gel for scars
only.[13] Topical silicone gel sheeting is cumbersome to
keep on the scar, and the patient compliance often is
low for lesions in visible areas.[14-16] Tapes or bandaging
frequently is not accepted. It may also lead to skin
irritation, which can require discontinuation of treatment,
especially in hot climates. Gel sheeting is effective for scar
control, but patient compliance with the method is not
always satisfactory.[17-19] Steroid injections are painful and
may lead to skin atrophy and dyschromies. They usually
are contraindicated for large areas and for children.
Topical silicon gel application can overcome some of
these limitations.
Self drying silicone gel is appealing because it is
effective, no xation is required; it is invisible when
dry; and sun blocks, makeup or both can be applied
in combination.
However, on areas of the body covered by clothes, it
must be perfectly dry before the patient dresses, and this
may not be always practical. All the patients felt the gel
was easy to apply, but some complained of prolonged
drying time. The use of a hair dryer was recommended
to overcome this problem. When the scars are located
in visible areas, especially on the face, patients can
experience psychological discomfort with the visibility
of the treatment. In warm climates, skin reactions
are relatively common, often leading to treatment
interruption.[20,21]
conclusions
Topical silicon gel is safe and effective treatment for
hypertrophic and keloidal scars. It is easy to apply and
cosmetically acceptable.
references
1. Tuan TL, Nichter LS. The molecular basis of keloid and hypertrophic
scar formation. Mol Med Today 1998;4:19-24.
2. Dyakov R, Hadjiiski O. Complex treatment and prophylaxis of post-burn
cicatrization in childhood. Ann Burns Fire Disasters 2000;13:238-42.
3. Ahn ST. Topical silicone gel: A new treatment for hypertrophic scars.
Surgery 1989;106:781-7.
4. Ahn ST. Topical silicone gel for the prevention and treatment of
hypertrophic scar. Arch Surg 1991;126:499-504.
5. Beranek JT. Why does topical silicone gel improve hypertrophic scars?
A hypothesis. Surgery 1990; 108:12-18.
6. Quinn KJ. Silicone gel in the scar treatment. Burns 1987;13:833-5.
7. Sawada Y, Sone K. Treatment of scars and keloids with a cream
containing silicone oil. Br J Plast Surg 1990;43:683-6.
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hypertrophic and keloids scars. J Wound Care 2000;9:10-2.
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14. Carney SA, Cason CG, Gowar JP. Cica care gel sheeting in the
management of hypertrophic scarring. Burns 1994;20:163-7.
15. Perkins K, Davey RB, Wallis KS. Silicone gel: A new treatment for burn
scars contractures. Burns Incl Therm Inj 1983;9:201-6.
16. Mercer NS. Silicone gel in the treatment of keloid scars. Br J Plast Surg
1989;42:83-8.
17. Dockery GL. Treatment of hypertrophic and keloid scars with silastic
gel sheeting. J Foot Ankle Surg 1994;33:110-9.
18. Cruz-Korchin NI. Effectiveness of silicone sheets in the prevention of
hypertrophic breast scars. Ann Plast Surg 1996;37:345-8.
19. Gibbons M, Zuker R, Brown M, Candlish S, Snider L, Zimmer P.
Experience with silastic gel sheeting in pediatric scarring. J Burn Care
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20. Borgognoni L, Martini L, Chiarugi C, Gelli R, Reali UM. Hypertrophic
scars and keloids: Immunophenotypic features and silicone sheets to
prevent recurrences. Ann Burns Fire Disasters 2000;8:164-6.
21. Nikkonen MM, Pitkanen JM, Al Qattan MM. Problems associated with
the use of silicone gel sheeting for hypertrophic scars in the hot climate
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Source of Support: Nil, Conict of Interest: None declared.
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