The efficacy and safety of silicone sheeting for the treatment and prevention of scars is supported by an abundance of clinical studies. In fact, there have been more controlled clinical trials performed on the treatment of scars using silicone sheeting than most other methods.
“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.”
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
A Collection of Clinical Studies, Professional Articles and Reviews on the Efficacy of Silicone Sheeting for the Treatment and Prevention of Hypertrophic Scars and Keloids
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.
Excerpts:
“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.”
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”
Mustoe TA, Cooter RD, Gold MH, et al. International Clinical Recommendations on Scar Management. Plast Reconstr Surg. 2002;110(2):560-571.
The article provides evidence-based recommendations on prevention and treatment of abnormal scarring and, where studies are insufficient, consensus on best practice. The recommendations focus on the management of hypertrophic scars and keloids, and are internationally applicable in a range of clinical situations. These recommendations support a move to a more evidence-based approach in scar management. This approach highlights a primary role for silicone gel sheeting and intralesional corticosteroids in the management of a wide variety of abnormal scars. The authors concluded that these are the only treatments for which sufficient evidence exists to make evidence-based recommendations
“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.”
This approach highlights a primary role for silicone gel sheeting and intralesional corticosteroids in the management of a wide variety of abnormal scars. The authors concluded that these are the only treatments for which sufficient evidence exists to make evidence-based recommendations
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.
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.
Tandara AA, Mustoe T. The role of the epidermis in the control of scarring: evidence for mechanism of action for silicone gel. J Plast Reconstr Aesthet Surg. 2008;61(10):1219-1225.
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.
Effectiveness of Silastic Sheet Coverage in the Treatment of a Keloid Scar:
Ohmori S. Aesthetic Plastic Surgery 1988 ; 12: 95-99
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.
Zurada JM. Topical treatments for hypertrophic scars. J Am Acad Dermatol. 2006;55(6):1024-1031.
Silicone gel sheeting for the prevention and management of evolving hypertrophic and keloid scars.
Fulton JE Jr. Institute for Skin Research, Newport Beach, California 92660, USA.
BACKGROUND. Hypertrophic scars and keloids remain a problem for surgeons. Topical and intralesional corticosteroids, positive pressure dressings, cryotherapy, and laser therapy are helpful but not uniformly successful. OBJECTIVE. To document the effectiveness of silicone gel sheeting in the prevention and/or reduction of evolving hypertrophic scars and keloids. METHODS. Silicone gel sheeting was placed over evolving scars in 20 cases. The dressing was worn for at least 12 hours a day. Biopsies were examined for the presence of silica in the tissue. RESULTS. Lesions improved during the treatment period in 85% of the cases. The mechanisms of action are unknown. Positive pressure was not necessary. No silica from the dressing was found at the wound site. CONCLUSION. Daily treatments with silicone gel sheeting should begin as soon as an itchy red streak develops in a maturing wound. The dressing is effective in reducing the bulk of these 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.”
A Randomized,Placebo-Controlled, Double-Blind, Prospective Clinical Trial of Silicone Gel in prevention of Hypertrophic Scar Developent in Median Sternotomy Wound Kin Yoong Chan, M.R. C.S. Ed., Chee Lan Lu, B. Sc. Pharm., Syed Mohd Adeeb, MS, Sathappan Somsaundaram, F.R.C.S., and Mohd Nasari-Zahari, F.R.C.S. Kuala Lumpur, Malaysia
Background: Hypertrophic scarring caused by sternotomy is prevalent among Asians. The effectiveness of silicone gel in scar prevention pay influence the decision of surgeons and patients regarding its routine use during the postoperative period.
Methods: The authors conducted a randomized, placebo-controlled, double-blind, prospective clinical trial. The susceptibility to scar development varied among patient; therefore, sternal would were divided into the upper half and lower half. Two types of coded gel prepared by an independent pharmacist were used on either half. Thus, selection and assessment biases and confounders were eliminated. Results: One hundred wounds in 50 patients were randomized into two arms, patients control and 50 silicone gels. The median age was 61 years and there were 35 men and 16 women. Ethnic distribution was 28 Malays, 18 Chinese and four Indians. No side effect caused by the silicone gel was noted. Ninety-eight percent of patients had moderate to good compliance. The incidence of sternotomy scar was 94 percent. At the third month postoperatively, the silicone gel wounds were scored lower when compared with the control wounds. The differences were statistically significant in all parameters, including pigmentation (p= 0.20), vascularity (p= 0.001), pliability (p= 0.001), height (p= 0.001), pain (p= 0.001), and itchiness (p= 0.02). Conclusions: The effect of silicone gel in prevention of hypertrophic scar development in sternotomy wounds is promising. There are no side effects and patients’ compliance is satisfactory. This study may popularize the use of silicone gel in all types of surgery to minimize the formation of hypertrophic scars in the early postoperative period. (Plast. Reconstr. Surg. 116: 1013, 2005.)
Topical silicone gel for the prevention and treatment of hypertrophic scar.
Department of Surgery, Washington University School of Medicine, St Louis, Mo 63110.
Abstract
We studied the effects of a silicone gel bandage that was worn for at least 12 hours daily on the resolution of hypertrophic burn scar. In a second cohort, the prevention of hypertrophic scar formation in fresh surgical incisions by this bandage was also evaluated. In 19 patients with hypertrophic burn scars, elasticity of the scars was quantitated serially with the use of an elastometer. An adjacent or mirror-image hypertrophic burn scar served as a control. Scar elasticity was increased after both 1 and 2 months compared with that in controls. There was corresponding improvement clinically that persisted for at least 6 months. In the other cohort, scar volume changes in 21 surgical incisions were measured before and after 1 and 2 months. Gel-treated incisions gained less volume than control incisions after both intervals. Clinical assessment corroborated this quantitative demonstration of a decrement in scar volume. We concluded that topical silicone gel is efficacious, both in the prevention and in the treatment of hypertrophic scar.
Arch Surg. 1991 Apr;126(4):499-504..
Hypertrophic scars and keloids : etiology and management.
Alster T, Tanzi E. The Washington Institute of Dermatologic Laser Surgery, Washington, USA.
Keloid and hypertrophic scars have affected patients and frustrated physicians for centuries. Keloid and hypertrophic scars result from excessive collagen deposition, the cause of which remains elusive. Clinically, these scars can be disfiguring functionally, aesthetically, or both. A thorough understanding of the pathophysiology and clinical nature of the scar can help define the most appropriate treatment strategy. Although many articles have been published on the management of hypertrophic and keloid scars, there is no universally accepted treatment protocol. Prevention of keloid and hypertrophic scars remains the best strategy; therefore, those patients with a predisposition to develop excessive scar formation should avoid nonessential surgery. Once a scar is present, there are many treatments from which to choose. Hypertrophic scars and keloids have been shown to respond to radiation, pressure therapy, cryotherapy, intralesional injections of corticosteroid, interferon and fluorouracil, topical silicone or other dressings, and pulsed-dye laser treatment. Simple surgical excision is usually followed by recurrence unless adjunct therapies are employed. Biologic agents that are directed towards the aberrant collagen proliferation that characterizes keloid and hypertrophic scars might be an important addition to the current armamentarium of modalities in the near future.
Am J Clin Dermatol. 2003;4(4):235-43.
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)
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.”
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
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
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…”
The Pharmacy Times continuing education course entitled Contemporary Options for the Management of Scars recognizes silicone sheeting as the topical scar product with the strongest clinical evidence for both treating and preventing scars.
Clinical Findings and overall efficacy of silicone sheeting:
Strong Clinical evidence of effectiveness in preventing and treating scars, including abnormal scars.”
Of the 8 Types of Topical Scar Products addressed in this course material, Silicone sheeting is listed as the treatment with the strongest clinical evidence for both treating and preventing scars.
