The latest issue of the Plastic and Reconstructive Surgery Journal December 2013 had an article, “Update on Scar Management: Guidelines for Treating Asian Patients.” The study was out of Seoul, Korea, Shanghai, Tokyo, and Chicago. (The Chicago branch was Dr. Mustoe, a plastic surgeon out of Northwestern who does a lot of scar treatment research.)
Background? “Following injury, Asian skin has a tendency toward hyperpigmentation and scar formation.” This was a literature search for abstracts, clinical trials, and meta analyses. Based on all the data, a panel of experts made a treatment recommendation regimen for Asian patients.
Findings?
- Following surgery scar prevention should be initiated in all Asian patients due to high risk of poor scars.
- There is strong evidence for the efficacy of silicone based products
- Ease of use
- Gel versus silicone sheets have both demonstrated efficacy
- If you do not respond to first line therapy (silicone topical treatments), consider intralesional steroid injections, radiation therapy, or intralesional 5 FU injections.
- Laser treatments are increasingly used, though evidence remains largely anectodotal
- There is still no clear consensus on optimal wavelength or amount of energy
- Surgical treatments are increasingly sophisticated, focusing on lowering tension on the scar.
They have an algorithm with all scars getting silicone gel therapy. If the scars start to elevate, continue with the silicone gel, and consider multiple sessions of lower fluence pulse dye laser. If you start to keloid (where the scar outgrows the original scar), then steroid injection, combined cutting it out and steroid injection, or for high risk recurrent keloids, escalating doses of radiation can also be used.
My thoughts?
I have already drank the Kool Aid on this one. I recommend liquid silicone gel (and carry it in my office) because there was a good study which came out a few years ago comparing kelocote (liquid silicone topical gel scar cream), mederma, vitamin E, and nothing and looked at the resultant scars. The one which did the best was the topical silicone gel cream. There are a number of products on the market. I carry Kelocote and Biocorneum (kelocote with sunscreen in it.) As with all things, the most important thing for scar care is doing the treatment.
This study focused mostly on hypertrophic or keloid scars- where the scars raise and elevate. For pigment issues only, hydroquinone is also used.
I have many blogs about scar care.