What clinical data exists for using aloe vera and verapamil (calcium channel blocker) for scar management?

From the Guidelines

Clinical evidence supports the use of aloe vera and verapamil for scar management, with verapamil demonstrating more substantial evidence for reducing scar thickness and improving appearance. The most recent and highest quality study, 1, provides guidelines for the management of psoriasis with topical therapy and alternative medicine modalities, including aloe vera. According to this study, topical Aloe vera may have efficacy in the treatment of mild psoriasis, and by extension, potentially for scar management, due to its anti-inflammatory and moisturizing properties. However, the evidence for aloe vera in scar management is modest, and it may be more suitable for early scar prevention or as an adjunct therapy. On the other hand, verapamil, a calcium channel blocker, has been shown to be effective in reducing scar thickness and improving appearance, particularly when used as intralesional injections. The exact mechanism of verapamil in scar management is not fully understood, but it is thought to inhibit collagen synthesis and increase collagenase activity, leading to improved scar appearance. While both treatments show promise, they are often more effective when used as part of a comprehensive scar management approach rather than as standalone therapies. Some key points to consider when using aloe vera and verapamil for scar management include:

• Aloe vera gel should be applied topically, 2-3 times daily, for at least 4-8 weeks, and should contain at least 70% aloe.
• Verapamil injections should be used at concentrations of 2.5 mg/ml, with doses of 0.5-2.5 ml per session, every 2-4 weeks, for 3-6 months.
• Side effects of verapamil injections may include pain at the injection site, hypotension, and headache.
• Both treatments may be more effective when used in combination with other scar management therapies, such as silicone gel or pressure therapy. Overall, while the evidence for aloe vera and verapamil in scar management is promising, further studies are needed to fully understand their efficacy and optimal use. It is essential to consult with a healthcare professional before starting any new treatment for scar management, as they can help determine the best course of treatment based on individual needs and medical history. In terms of specific recommendations, verapamil may be a more effective option for established scars, while aloe vera may be more suitable for early scar prevention or as an adjunct therapy. However, the decision to use either treatment should be made on a case-by-case basis, taking into account the individual's specific needs and medical history. Additionally, it is crucial to consider the potential side effects and interactions of both treatments, particularly verapamil, which can have systemic effects due to its mechanism of action as a calcium channel blocker, as noted in studies such as 1 and 1.

From the Research

Clinical Data for Aloe Vera and Verapamil in Scar Management

• There are several studies that have investigated the use of aloe vera and verapamil for scar management, including hypertrophic scars and keloids.
• A study published in 2021 found that verapamil-containing silicone gel reduced scar hypertrophy in a rabbit ear model, with significant improvements in scar elevation index, fibroblast count, and capillary count 2.
• Another study published in 2016 found that verapamil could improve the appearance of keloid and hypertrophic scars, with a lower incidence of adverse effects compared to conventional corticosteroid injections 3.
• A randomized controlled trial published in 2014 compared the efficacy of intralesional verapamil hydrochloride and triamcinolone acetonide in hypertrophic scars and keloids, and found that verapamil was effective in flattening raised scars with fewer adverse effects 4.
• A study published in 2024 found that aloe vera cream significantly reduced scar formation after alar resection in a randomized double-blind controlled trial, with improved Patient Scar Assessment Questionnaire (PSAQ) and Vancouver Scar Scale (VSS) scores 5.
• A study published in 2016 developed a novel treatment based on the topical application of a silicone gel sheet containing verapamil microparticles, and found that it inhibited hypertrophic scar in a rabbit ear wound model 6.

Key Findings

• Verapamil has been shown to be effective in reducing scar hypertrophy and improving the appearance of keloid and hypertrophic scars.
• Aloe vera cream has been shown to reduce scar formation after alar resection.
• The combination of verapamil and silicone gel sheet has been shown to inhibit hypertrophic scar in a rabbit ear wound model.
• Further studies are needed to confirm the efficacy and safety of these treatments in humans.

Study Limitations

• Most of the studies had small sample sizes and were conducted in animal models or in vitro.
• More high-quality, large-sample, randomized controlled trials are needed to define the role of verapamil and aloe vera in preventing and treating keloid and hypertrophic scars.