Scarring and Keloids ↓

Emerging scar therapies can help treat and prevent painful, unsightly scars. At the surface, a wound from trauma or surgery may leave a scar that is raised and discolored; at a deeper level, blood vessel and nerve damage can result in associated pain and itching. Therefore, the best therapies involve a multi-prong approach to help smooth and lighten the physical appearance of the scar, while controlling or eliminating associated discomfort. Individually compounded scar therapy preparations may contain caffeine; vitamin A; avocado, coconut, and other tree oils; and medications including corticosteroids, antihistamines, as well as other agents such as verapamil that promote healing. Taking an individualized approach to treating scars with compounded topical scar therapy can be an important adjunct in the treatment of wounds and scars.

J Natl Med Assoc. 2004 Jan; 96(1): 108–116.

Prevention and treatment of excessive dermal scarring.

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Topical Pracaxi Oil Base for Scar and Wound Therapy

The objective of a case series by Banov et al. was to evaluate the utility of fatty acids found in pracaxi oil for wound and scar therapy. Initially, 21 patients with various surgical, traumatic, or burn wounds and scars were enrolled. A topical anhydrous silicone base containing pracaxi oil was applied alone or was compounded to include one or more additional medications tailored to the specific needs of each patient, such as 1% pentoxifylline, 1% caffeine, 1% tranilast, or 2% mupirocin. Patients were advised to apply the compounded topical medication to new or existing scar or wound areas by lightly massaging the compound into and around the scar or wound. The recommended application frequency was two to four times daily based on the attributes of the scar or wound. The mean duration of application of the compounded topical anhydrous base containing pracaxi oil was 11 days and ranged from 48 hours to 3 weeks based on the size and severity of the wound or scar.

The study found that the application of a compounded anhydrous silicone base containing pracaxi oil alone or in combination with other active substances led to considerable improvements in wound healing and scar attributes and is a potentially useful option in the treatment of burns or surgical, or traumatic wounds and scars.

Dermatol Ther (Heidelb). 2014 Dec;4(2):259-69.

Case series: the effectiveness of Fatty acids from pracaxi oil in a topical silicone base for scar and wound therapy.

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Topical Curcumin: A Review of Mechanisms and Uses in Dermatology

Curcumin is the active ingredient in the spice turmeric. While the effectiveness of oral curcumin is hindered by low bioavailability due to poor absorption by the oral route, this is not the case for topical curcumin.

Curcumin’s anti-inflammatory and anti-apoptotic activity is based on its inhibition of the enzyme phosphorylase kinase. Phosphorylase kinase is released within 5 minutes after injury. By inhibiting phosphorylase kinase in the injury pathway, curcumin blocks the activation of NF-kB, the transcription activator responsible for activating genes related to proliferation of inflammatory cells (T cells and macrophages), cell migration, cell cycling, epidermal proliferation, and fibroblast proliferation. Therefore, treatment with topical curcumin may reduce scarring and keloid formation. Apoptosis may allow more rapid replacement of the injured cells by normal healthy cells and may assist with wound healing. Following treatment with topical curcumin, more rapid healing has been observed in traumatic wounds, burns, and sun-damaged skin.

Low aqueous solubility, poor tissue absorption, rapid metabolism and short plasma half-life have made oral curcumin unsuitable for systemic administration for wound healing. Therefore, the therapeutic potential of topical curcumin appears to be more promising than that of oral curcumin. Recently, various topical formulations of curcumin such as films, fibers, emulsion, hydrogels and different nanoformulations have been developed for targeted delivery of curcumin at wounded sites.

Topical curcumin has been shown to benefit conditions associated with skin injury and inflammation, including surgical scars, psoriasis, rosacea, sunburn and acne. Topical curcumin has also been found to be effective in decreasing the markers of lactational mastitis in breastfeeding women such as pain, breast tension and erythema within 72 hours of administration.

While there are other anti-inflammatory medications available, e.g. topical corticosteroids, the therapeutic benefit of topical curcumin lies in the general safety of the substance and the absence of observable side effects.

Int J Dermatol Clin Res 3(1):010-017.

Topical Curcumin: A Review of Mechanisms and uses in Dermatology

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Drug Discov Today. 2017 Oct;22(10):1582-1592.

Curcumin and its topical formulations for wound healing applications.

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Oman Med J. 2014 Sep;29(5):330-4.

Effectiveness of topical curcumin for treatment of mastitis in breastfeeding women: a randomized, double-blind, placebo-controlled clinical trial.

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Novel Scar Therapies

Verapamil exhibits anti-proliferative properties that reduce collagen deposits and promotes scar tissue breakdown by increasing collagenase production. Another often used drug is pentoxifylline. In vitro, pentoxifylline inhibits the production of collagen; topical application improves blood flow and elasticity of scar tissue. Other agents used in scar therapy include: imiquimod 5% (immune-response modifier and Toll-like receptor (TLR) agonist), hyaluronic acid (corporal lubricant), and tranilast (suppresses collagen synthesis by fibroblasts). With so many options available, the key is to work closely with our compounding pharmacist to find the preparation that will work best for your patient’s skin type, scar location, and stage of healing. Medications may be compounded into a cream, ointment, or gel base. Several studies show the benefits of a silicone gel base in the treatment of scars. The mechanism by which silicone aids in scar healing is not well understood. One possible role is the creation of a physical barrier to prevent water loss through damaged scar tissue. It is thought that promoting hydration and proper temperature and oxygen transmission creates an environment conducive to healing. In one study, a total of 36 post-operative patients applied silicone gel twice daily resulting in statistically significant improvements in scar height, pain, pigmentation, pliability, pruritus and vascularity.

Dermatol Ther (Heidelb). 2013 Dec;3(2):157-67.

Efficacy and safety of an advanced formula silicone gel for prevention of post-operative scars.

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Jpn J Pharmacol. 1992 Oct;60(2):91-6.

The mechanism involved in the inhibitory action of tranilast on collagen biosynthesis of keloid fibroblasts.

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J Am Acad Dermatol. 2006 Dec;55(6):1024-31.

Topical treatments for hypertrophic scars.

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Burns. 2014 Nov;40(7):1255-66.

Up-to-date approach to manage keloids and hypertrophic scars: a useful guide.

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Silicone Gel for Treatment of Fresh Surgical Scars

A randomized controlled trial studied 110 patients (55 men, 55 women) who had undergone outpatient surgery at the Department of Dermatology, University of Florence. The patients were divided into two groups: a treatment group (group A) and a control group (group B). Subjects (n = 65) in group A were prescribed silicone gel to be applied to the wound twice a day for 60 days after the removal of stitches. Subjects (n = 45) in group B were prescribed the use of zinc oxide cream. All subjects, in both study and control groups, were examined by the same dermatologists every month for 3 months after surgery, then every 2 months for a total follow-up of 8 months from the date of surgery. In the treatment group, only 18 patients (27%) had formation of a non-physiological scar: diastasic scar in 10 patients (15%), hypertrophic scar in 6 (9%) and atrophic scar in 2 (3%). No keloid scars were recorded. In the control group, 25 (55%) had an altered scar: keloid scars in 5 patients (11%), hypertrophic scar in 10 (22%), diastasic scar in 8 (18%) and atrophic scar in 2 (4%). The results of this study indicate that silicone gel is able to reduce the formation of keloid and hypertrophic scars and the signs/symptoms associated with the healing process (paraesthesia, pulling sensation, alterations in color).

Clin Exp Dermatol. 2009 Aug;34(6):688-93.

The use of silicone gel in the treatment of fresh surgical scars: a randomized study.

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EGCG for Wound Healing and Scar Prevention

EGCG (the polyphenols in green tea) may potentially accelerate the wound-healing process and prevent scarring. This potential benefit is particularly exciting for people with conditions such as diabetes, which inhibits the wound-healing process.

Green Tea Linked To Skin Cell Rejuvenation.

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Br J Plast Surg 1998 Sep;51(6):462-9

Topical tamoxifen–a potential therapeutic regime in treating excessive dermal scarring?

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