Best Over-the-Counter Cream for Treating Scars
Silicone-based gels are the gold standard, first-line OTC treatment for scars, recommended by international expert consensus as the most effective non-invasive option available without prescription. 1
Primary Recommendation: Silicone Gel
Use topical silicone gel as your first-line treatment for scar management. 1 Silicone products work by creating optimal hydration and occlusion of the scar tissue, which reduces fibroblast activity and prevents hypertrophic scar formation. 2
Why Silicone Gel Over Silicone Sheets
- Silicone gel is preferable to silicone sheets because sheets cause excessive occlusion leading to pruritus, irritation, maceration, and difficulty applying for more than 10-12 hours. 2
- Liquid silicone gels provide comparable effectiveness to sheets while avoiding these complications and facilitating easier application to irregular surfaces and larger areas. 2
- Apply silicone gel and allow it to dry completely (note: drying time can be prolonged and the gel may leave a shiny appearance). 2
Evidence Strength
- High efficacy for prevention of hypertrophic scars when used on newly healed wounds. 3
- High efficacy for treatment of existing hypertrophic scars, with statistically significant reduction in scar thickness (mean difference -2.00 mm) and color improvement. 4
- However, the overall quality of evidence is limited by small studies with methodological concerns. 4, 5
Alternative OTC Option: Specific Moisturizers
If silicone gel is not tolerated or cost is prohibitive, certain moisturizers (specifically Alhydran or DermaCress) provide superior occlusion and hydration compared to silicone gel. 2
- These moisturizers demonstrated better cumulative absolute added hydration and sustained trans-epidermal water loss (TEWL) reduction over 4 hours compared to silicone gel. 2
- They offer a more cost-effective and patient-friendly application without the long drying time or shiny appearance of silicone. 2
- The key is selecting moisturizers with well-balanced occlusion and hydration properties—not all moisturizers are equivalent. 2
What Does NOT Work
Avoid onion extract products (such as those marketed for scars)—these have low efficacy for both prevention and treatment of hypertrophic scars despite widespread marketing. 3
Application Protocol
- Apply daily to the scar once the wound is completely healed and epithelialized. 1
- Continue treatment for several months—scar remodeling is a prolonged process. 1
- Combine with sun protection (SPF coverage) as UV exposure worsens scar appearance. 1
- Re-evaluate every 4-8 weeks to determine if additional interventions are needed. 1
When OTC Treatment Is Insufficient
If the scar is not improving after 2-3 months of consistent silicone gel use, or if the scar is keloid or severely hypertrophic, refer for invasive treatments including:
- Intralesional corticosteroid injections (high efficacy). 3
- Pulsed-dye laser or CO2 laser therapy (high efficacy). 3
- 5-fluorouracil or bleomycin injections (high efficacy). 3
Critical Caveat
For keloid scars specifically, the evidence for silicone gel is very uncertain—only two small trials exist with very low-certainty evidence, and we cannot confidently say whether silicone makes any difference for true keloids. 5 Keloids typically require more aggressive interventions beyond OTC options. 3