From the Guidelines
For pediatric patients, the primary approach to scar reduction involves careful handling and protection of the skin to minimize epidermal detachment and trauma, as recommended by the British Association of Dermatologists' guidelines 1. To achieve this, several measures can be taken:
- Handle the skin carefully and reduce shearing forces to minimize the extent of epidermal detachment.
- Limit epidermal trauma by avoiding the use of sphygmomanometer cuffs, adhesive electrocardiogram (ECG) leads, adhesive dressings, and identification wrist tags.
- Consider using soft silicone tapes to attach essential clinical items, such as cannula and nasogastric/nasojejunal tubes.
- Use silicone medical adhesive remover to remove adherent clothes or wound dressings.
- Apply soft bandages or tubular bandages to secure dressings and cannulas. Additionally, maintaining good skin care and hygiene practices, such as keeping the skin moisturized and protected from the sun, can also contribute to optimal scar reduction outcomes. It is essential to note that while silicone-based products are often used for scar reduction, the provided evidence does not specifically support their use in the context of pediatric patients with Stevens-Johnson syndrome/toxic epidermal necrolysis, which is the focus of the guideline referenced 1. Therefore, the primary approach should prioritize careful skin handling and protection, with other treatments considered on a case-by-case basis under the guidance of a specialist multidisciplinary team.
From the Research
Scar Reduction Measures for Pediatric Patients
- The use of silicone-based products is recommended for scar management in pediatric patients, as they have been shown to be effective in preventing and treating abnormal scarring 2, 3, 4, 5, 6.
- Topical silicone gel, such as Dermatix Ultra and Dermatix Ultra Kids, can be used to treat hypertrophic and keloid scars in children, and has been shown to be effective in improving scar appearance 2, 4.
- Pressure garment therapy can also be used in combination with silicone gel to manage burn scars in children, although the effectiveness of this combination is still being researched 4.
- Silicone gel sheeting is another option for treating hypertrophic scars in children, and has been shown to be superior to other treatments such as topical onion extract including heparin and allantoin 5.
- Nurses play an important role in supporting pediatric patients with scar management, including providing education on self-care and offering psychological support to address the potential impact of scarring on quality of life 6.
Treatment Options
- Topical silicone gel: effective for treating hypertrophic and keloid scars in children 2, 4.
- Silicone gel sheeting: effective for treating hypertrophic scars in children, and superior to other treatments such as topical onion extract including heparin and allantoin 5.
- Pressure garment therapy: can be used in combination with silicone gel to manage burn scars in children, although the effectiveness of this combination is still being researched 4.
Considerations for Pediatric Patients
- The use of silicone-based products is generally considered safe and effective for pediatric patients, although further research is needed to fully understand their effectiveness in this population 2, 3, 4, 5, 6.
- Nurses should provide education and support to pediatric patients and their families on scar management and self-care, including the use of silicone-based products and other non-invasive methods such as massage 6.