What is the recommended treatment for scars using silicon-based products?

Silicon-Based Treatment for Scars

Silicon-based products are the first-line treatment for hypertrophic and keloid scars, with silicone gel sheets and topical silicone gel showing equivalent efficacy in improving scar appearance, reducing roughness, and alleviating symptoms like itching.

Types of Silicon-Based Treatments

Silicone Gel Sheets

• Traditional treatment used successfully for over 30 years 1
• Applied directly to the scar and worn for 12-24 hours daily
• Requires proper adherence to the skin
• May be difficult to use around joints or on facial areas
• Typically used for 2-6 months depending on scar response

Topical Silicone Gel

• Newer formulation that forms a thin flexible sheet when applied from a tube 2
• Easier to apply than traditional sheets, especially on joints or facial areas
• Applied twice daily to clean, dry skin
• Dries within minutes to form an invisible, breathable layer
• Equivalent efficacy to silicone gel sheeting but with improved ease of use 2

Cohesive Silicone Bandages

• Newer option that combines pressure and silicone therapy
• May provide superior improvement in vertical elasticity compared to silicone gel sheets 3
• Particularly useful for larger scars or areas requiring additional pressure

Mechanism of Action

The exact mechanism of silicone therapy remains under investigation, but likely involves:

• Occlusion of the scar site
• Hydration of the stratum corneum
• Subsequent cytokine-mediated signaling from keratinocytes to dermal fibroblasts 2
• Normalization of overactive scar-related cell activity
• Possible static electricity effects 4

Clinical Evidence for Efficacy

Topical Silicone Gel

• Randomized controlled trials show significant improvement in:
  • Surface roughness (p=0.012 over all visits)
  • Significantly less roughness at 3 months after treatment initiation (p=0.014)
  • Reduced itching at 3 and 6 months (p=0.018 and p=0.013) 5

Silicone Gel Sheets vs. Silicone Cushions

• Both treatments effective in decreasing scar volume:
  • Silicone gel cushion: 53.0% reduction
  • Silicone gel sheeting: 36.3% reduction
  • Similar improvements in tenderness, itching, redness, and softening 4

Cohesive Silicone Bandages vs. Silicone Gel Sheets

• Cohesive silicone bandages showed statistically significant better performance for:
  • Vertical elasticity
  • Global score on the Patient and Observer Scar Assessment Scale 3

Treatment Protocol

1. Timing of Initiation:

   • Begin treatment as soon as the wound is fully epithelialized
   • Can be used on both new and mature scars, though earlier intervention is more effective

2. Application Method:

   • For silicone gel sheets:

     • Clean and dry the scar area
     • Cut sheet to size (extending 1-2 cm beyond scar borders)
     • Apply directly to scar
     • Secure with medical tape if needed
     • Wear for 12-24 hours daily
     • Wash sheet daily with mild soap and water

   • For topical silicone gel:

     • Clean and dry the scar area
     • Apply a thin layer twice daily
     • Allow to dry completely (3-5 minutes)
     • Can apply makeup or sunscreen after drying

3. Duration of Treatment:

   • Minimum 2-3 months for new scars
   • May require 6 months or longer for established scars
   • Continue until no further improvement is observed

Common Pitfalls and How to Avoid Them

• Skin irritation or rash:

  • Temporarily reduce wearing time of silicone sheets
  • Ensure skin is completely dry before application
  • Clean the sheet and skin more frequently

• Poor adherence:

  • Consider switching to topical silicone gel for difficult areas
  • Use medical tape to secure sheets if needed
  • For facial scars or areas with movement, topical gel may be preferable

• Insufficient treatment duration:

  • Patients should understand that scar remodeling is a slow process
  • Minimum 2-3 months of consistent use is required before evaluating efficacy

• Improper application:

  • Ensure scar is completely healed before beginning treatment
  • Apply silicone directly to the scar, extending slightly beyond its borders
  • Maintain consistent daily application schedule

Adjunctive Treatments

For scars not responding adequately to silicone therapy alone, consider:

• Pressure therapy (particularly for burns)
• Intralesional corticosteroid injections for hypertrophic or keloid scars
• Laser therapy for persistent erythema or textural irregularities

Silicon-based treatments remain the mainstay of non-invasive scar management due to their proven efficacy, safety profile, and ease of use.