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Everyone has experienced a burn, cut, or surgery that has left a scar. When the scar is located in an inconspicuous place, it is not so bad. When an existing scar or a new injury occurs in a noticeable place, however, patients will appreciate knowing that there are OTC products that can reduce the scar.
The Scarring Process
Scarring is part of the skin's natural healing process and occurs in 3 steps: inflammation, tissue formation, and remodeling. Fibroblasts proliferate in the wound and produce a tough, fibrous protein called collagen. Collagen fills and closes the wound in a disorganized manner, resulting in a scar.
Keloid scars occur when the body "overheals" the injury. Contracture scars occur when the skin tightens, often in response to a burn. Hypertrophic scars are red and raised, much like keloid scars, but they do not extend beyond the injury site. Acne scars may appear as deep pits or red spots. Treatment methods for scars include dermabrasion, laser surgery, steroid injections, prescription medications, and OTC creams, ointments, and gels.
OTC Treatment Options
Aloe vera gel is used topically to promote wound and burn healing and to reduce pain and inflammation. It contains carboxypeptidases and salicylate, which inhibit bradykinin, a substance that causes pain. Another ingredient is C-glucosyl chromone, a topical antiinflammatory agent. Additionally, inhibits thromboxane synthesis and may even have antibacterial and/or antifungal properties (Table).
Alpha hydroxy acids (AHAs) are natural fruit acids, including lactic acid, glycolic acid, and citric acid. AHAs are used topically to exfoliate, to treat stretch marks and acne scars, and to moisturize the skin. Adverse reactions may include stinging, irritation, burning, redness, swelling, and sloughing of the skin. Patients with sensitive skin should exercise caution when using AHA products due to the increased risk of adverse reactions. Sunscreen should be used regularly with AHA products because they cause increased sun sensitivity.
Furfuryladenine is a plant-derived growth hormone used topically to treat wrinkles, brown spots, blotchiness, and roughness and to increase the skin's moisture. It may be less irritating than AHA products and does not appear to increase photosensitivity.
Allium cepa, or onion extract, inhibits fibroblasts and has other antiinflammatory properties. The proprietary version of onion extract is Mederma.
Silicone gel or sheets are used to minimize the appearance of scars. They appear to work by hydrating the wound, resulting in the production of fewer fibroblasts. With fewer fibroblasts, there is less collagen, and the scar is flatter and lighter in color.
Vitamin E is the major lipid-soluble antioxidant in the skin. Antioxidants scavenge free radicals and prevent their formation. Vitamin E also may stabilize lysosomal membranes. Although vitamin E therapy is popular, topical use does pose a risk of contact dermatitis. To date, studies have not proven its efficacy in the treatment of scars.
Dr. Brown is coordinator of Kerr Drug Clinical Services at Kerr Health Care Center.