What should I know before buying silicone sheets or silicone gel for scars treatment?

What should I know before buying silicone sheets or silicone gel for scars treatment?

Silicone sheets, as well as silicone gel for treatment of scars are quite expensive. They might help somebody, somebody not. What you need to know before buying silicone sheets or scar gel? In what cases can the purchase of a scar gel or silicone sheets turn into a money loss? For the right choice of a silicone sheet or silicone gel we need to understand the way how they work on scars. This will be discussed below…

The main brands of silicone sheets in this market segment are Mepiform (Fig. 1), Cica Care (Fig. 2), Scar Fx ” (Fig.3).

Varieties of silicone sheets for scars

How does the silicone sheet work on a scar?

It is believed that the main action mechanism of the silicone sheet on a scar is the retention of water molecules in the scar tissue. In other words, the silicone sheet covers the scar and prevents water evaporation from its surface. By moistening the scar, connective tissue cells move faster, divide and exchange information through water more freely. As a result, a normotrophic scar is formed. Collagen fibers in such a scar are located parallel to the skin surface. All this is true if we are talking only about the usage of the silicone sheets to atrophic or normotrophic scars during their maturation.

Using of Mepiform silicone dressing. What happens in a scar? 

Mepiform is a thin flexible dressing used for small scars after injuries, operations, abrasions and cuts. Mepiform should optimally be worn for 24 hours a day. During using time the silicone dressing creates a certain microenvironment in the scar area. This microenvironment provides good moisture and blood circulation for rapid cell division and collagen synthesis. As a result of the Mepiform silicone sheets usage an elastic normotrophic scar is formed. 

Completely different to treat are the hypertrophic and keloid scars … 

What happens in a keloid and in a hypertrophic scar?

The Mepiform silicone sheets are not suitable for the treatment and prevention of hypertrophic and keloid scars! And that’s why … 

In pathological scars, other processes occur than in atrophic and normotrophic scars. In keloids, on the contrary, there is an increased division of cells and an uncontrolled increased collagen synthesis. Unlike normotrophic and atrophic scars, keloids are saturated with moisture (an edema is present). In order to grow, the keloid and hypertrophic scar must receive oxygen. And to get more oxygen, you need a more extensive network of blood vessels. To create this additional vascular network, the scar releases certain substances that stimulates the formation of new vessels. Growing keloids and hypertrophic scars are red because they constantly form new vessels (Fig. 4).

Now imagine what will happen if a thin Mepiform silicone sheet is applied to the surface of a keloid or a hypertrophic scar? At best, it won’t help! At worst, it will create a greenhouse effect and gives rise to even more swelling and further collagen synthesis increase. 

Which silicone sheets are suitable best for keloids and hypertrophic scars? 

The task is to compress the blood vessels that feed the scar for a long time. In this way, oxygen delivery to a keloid or to a hypertrophic scar can be blocked. When the blood vessels are compressed local ischemia and oxygen starvation occurs. If the supply of oxygen to the scar is sharply reduced or stops completely, the collagen synthesis also decreases (Fig. 5-6). 

For the treatment of keloid and hypertrophic scars, it is advisable to use thick and heavy silicone sheets with a good adhesive base. Only such a silicone sheet will fit snugly against the skin and press the keloid or hypertrophic scar with its mass. The most common brands of such silicone dressings are: Scar Fx and Cica Care. The main substance that is part of silicone sheets is polyorganosiloxane (simplistically molten sand mixed with organic ingredients).

Due to prolonged ischemia (lack of oxygen), cells gradually slow down their division. As a result, collagen synthesis decreases, the scar turns pale, decrease in size and becomes more elastic (Fig. 7). 

VERY IMPORTANT! If the keloid is very large and highly elevated above the skin surface, then the silicone sheet will not fit snugly and therefore there will be no vascular compression effect. No result means waste of money! Therefore, it is necessary first to “set down” the scar, and only then continue the treatment with silicone plates (Fig. 8-12).

Another key point in the effect of silicone sheets on a keloid scar is the creation of a mechanical barrier. Without a silicone sheeting nothing holds the cells back, they move freely, divide and grow upwards. Another thing is when a silicone sheet presses on the keloid or hypertrophic scar. The cells in the scar become constrained in movement, they have nowhere to divide and grow, because a silicone sheet presses on them.

Thus, the effect of a silicone patch on a keloid and a hypertrophic scar comes down to two key points: 

1. Pressure on the blood vessels that feed the scar and the creation of local ischemia. Confirmation of this is a pale scar when you remove the plate.

2. Mechanical obstruction for dividing cells (fibroblasts) that synthesize collagen – the substrate of the scar.

Conclusions: 

1. Mepiform silicone sheet can be used on atrophic and normotrophic scars after cuts, injuries, operations during their maturation immediately after wound closure. Purpose of application: formation of an elastic normotrophic scar and elimination of the vascular component (redness) in the scar. Do not use on a keloid scar! There will be no result! 

2. Silicone sheets Scar Fix and Cica Care are intended for prevention (if the patient already had pathological scars) and combined treatment of hypertrophic scars and keloids. Indications: burn and postoperative scars after skin transplantation, scars after mammoplasty, scars after caesarean section.

How does silicone gel for scars work? 

Despite all the variety of silicone gels (Fig. 13), the mechanism of their action is identical, and the difference is only in the price. In terms of its action, the silicone gel is similar to the Mepiform silicone sheet, only inferiors significantly to it in terms of effectiveness. Silicone gel is used for scars localized on the face, joints, on mobile areas of the skin where it is impossible to fix a silicone sheet.

Fig.13. Variety of silicone gels

Of all silicone gels, perhaps the most effective is Scarguard (Fig. 14). In addition to polyorganosiloxane the composition of Scarguard includes the hormone hydrocortisone and vitamin E. Hydrocortisone removes the inflammatory component and swelling, and vitamin E regenerates tissues. All this happens under the silicone film that the Scarguard gel creates on the surface of the skin.

VERY IMPORTANT! No silicone gel can help treat keloids! All silicone gels for scars are intended for the treatment of fresh scars during their maturation, as well as for the prevention and treatment of HYPERTROPHIC scars, but NOT KELOIDS (Fig. 15).

Conclusions:

1. Silicone gels can be used for small fresh atrophic, normotrophic and hypertrophic scars at an early stage of their maturation (in the first 3-4 months). 
2. Silicone gels are used on flexion and extensor surfaces in the joint areas.
3. Silicone gels do not have any effect on keloids.

Does it make sense to use silicone sheets or silicone gel for old scars?

Based on the above described action mechanism of silicone sheets and silicone gel for scars a logical conclusion suggests itself: neither silicone sheets nor silicone gels can neither change nor destroy the structure of an already mature scar. They can only slightly soften it due to the greenhouse effect, and even then only for the usage duration of the silicone sheet. Whatever the manufacturers of these products claim, 

USING SILICONE SHEETS OR SILICONE GELS FOR OLD SCARS IS USELESS!