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About Scars - SCARmed

About Scars

What is a scar?

Any damage to the skin from trauma of some kind will almost always result in a Scar. When an injury to the skin goes deeper than the top layer of the skin (epidermis) and into the middle larger (dermis), a scar may be formed as part of the healing process. Scars may also form as a result of surgery or disease. The chance of a patient being left with a noticeable scar depends on how deep the skin is damaged as well as size of the surface area. The deeper the skin is damaged, the greater the chance that a patient will be left with a scar.

Scars have a different structure to normal skin. The scar tissue consists of newly synthesized collagen fibres. The collagen makes the scar less flexible and weaker than normal skin. Hence the reason a scar will have a different appearance than normal skin.

There are numerous factors that will influence a person’s skin healing process. Apart from an individual’s intrinsic factors, environmental or extrinsic factors such as hydration, age, skin type and any chronic condition, such as diabetes etc., will influence the healing process.

Types of Scars

Pale Normal Scar

A Normal Scar is usually the most common type of scar and seen as a pale fine line on the skin. This type of scar usually develops after wound closure and will fade within 3 months or longer.

Hypertrophic Scars

These scars are usually red, thick and elevated. Their growth is confined within the boundaries of the original wound and can be itchy and painful. These scars generally appear within 4 weeks after trauma and may improve naturally, but can remain discoloured and raised for a number of years.

Keloid Scars

Keloid Scars are thick, rounded, irregular clusters of scar tissue that extend beyond the original wound. They often appear red or darker in colour and the onset of keloids appear generally at 3 months and can be delayed up to several years after injury.

Atrophic Scars

Atrophic scars are often cause by inflammation and are formed when the healing process is disrupted and insufficient new connective fibres are formed with acne or infections such as chicken pox. These scars are sunken down into the skin, looking like small, round depressions below the surface of the skin.

Contractive Scars

A contractive scar is caused by permanent constriction of the skin after a burn, hence the name. If the injury is extremely severe, there may be damage to the nerves underneath the skin as well as to the muscle and tendons. The timeline after the formation of a contractive scar is to peak in a period from 3 to 6 months.

Wound Healing And Skin Structure

The skin is the largest organ of the body, with a total area of about 20 sq. ft. The skin protects us from microbes and the elements, helps regulate body temperature and permits the sensations of touch, heat and cold.

Skin Has 3 Main Layers:

  • The epidermis, the outermost layer of skin, provides a waterproof barrier and creates our skin tone.
  • The dermis, beneath the epidermis, provides touch connective tissue, hair follicles and sweat glands.
  • Hypodermis, the deeper subcutaneous tissue, is made up of fat and connective tissue.

Damage To The Skin or a Wound Goes Through a Continuous Repair And Healing Process That Normally Involves 4 Distinct Phases.

Phase 1 – Haemostasis

This is the first step whereby the bleeding is stopped. Immediately after an injury to the skin that causes bleeding, the blood vessels constrict and reduce the flow of the blood to the injury site. Blood clots form within the injured blood vessels and block the flow of blood from the wound.

Phase 2 – Inflammatory

The second phase of wound healing occurs between day 3 to day 20. Soon after the bleeding stops, an inflammatory reaction starts in the injured tissue. This process triggers migration of various cells to the wounded tissue as well as the initiation of complex chemical reactions that will lead to growth of cellular structure of the skin.

Phase 3 – Proliferative

In the 3rd phase, the cellular elements of the skin start Proliferating and replicating to build new tissue and replace the tissue and cellular elements that were damaged and destroyed in the process of wounding. The wound is generally pulled closed as the production and deposition of collagen rebuilds the tissue.

Phase 4 – Remodelling

In the final phase of wound healing, remodelling or maturation takes place whereby the inflammation is gradually resolved and collagen is deposited. New tissues will take the form of the original tissue and fills up the injury, thereby forming scar tissue. As more collagen is laid down, the scar becomes thicker and stiffer. Although the wound may appear to have healed well after a few months, the scar tissue does not gain the same strength as the normal tissue before. Within time, scars generally become smaller, however it could take several months to years for the healed wound to gain the strength of normal tissue. Although most scars could become flatter over time, raised scars could persist due to the overproduction of collagen. This could result in either hypertrophic or keloid scars.

Factors That Trigger Scar Formation

Injury to skin can lead to formation of scars. There are other factors that can also contribute to the size and shape of the scar.

  • Wound Infection: Any form of infection at the wound site will lead to a delay in wound healing and could lead to a more pronounced scarring of the skin.
  • Wound Dehiscence: When some wound opens, either due to stretching or an infection, the final end result, appearance of the wound and the size and shape of the scar will be significantly pronounced.
  • Manipulating the wound: Nature knows how to heal itself. A healing wound should not be unnecessarily interfered with actions such as removing scabs etc. An inferior outcome could occur as a result of damage to the fresh skin that is forming.
  • Genetic predisposition: Certain individuals and ethnic groups are prone to heavy scarring. Hypertrophic scarring and keloid formation often run in families or even in ethnicities.

Scar Treatment and Management

Clinical treatment options for both hypertrophic and keloid scars include surgery and scar injected steroids, both of which can be very painful. The number of options available for consumers to purchase over the counter can at first be confusing. It is important to know that very few products have actually been clinically proven to make a difference to your scar. [2]

Silicone-based products are widely used in the management of hypertrophic scarring and keloids. Silicone gel sheeting has been used successfully for more than 30 years in scar management. [1]

Which Type of Scars is SCARmed Most Suitable for?

SCARmed is used for the treatment and prevention of Keloids, Atrophic, Contractive, and Hypertrophic scars (such as those resulting from general surgical procedures, trauma wounds and burns), ideally used just after the wound has freshly healed and the skin surface becomes intact. It may also be used for prominent red immature scars that are actively healing; often up to two years post wound closure.

Post-surgical Scars

SCARmed is most effective if used in the early treatment of scars resulting from surgery, burns and other injuries (prevention phase). This includes scars from caesarean operations, breast surgery, cosmetic surgery, maxillofacial surgery and other surgical procedures.

References

1.Mustoe TA. AesthPlastSurg 2008 32:82-92
2.Mustoe TA et al. PlastReconstrSurg2002;110:560-571

Clinical Data

Scar Management & Observation Study

Objective: The objective of this 1522 patient study was to evaluate the efficacy of the Silicone Gel technology in treating redness, itchiness, pain and elevation. Physician and patient assessments were also carried out to measure tolerability of the treatment.

Study Design and Patients:

Study involved 66 dermatologists for a period of over 20 months, a total number of 1522 patients between 1 to 94 years of age who had hypertrophic or keloid scars, predominantly these were newly formed scars (< months) but also old scarring that had existed at least 4 years. The origin of scar formation included surgical procedures, accidental, burn/scalding and other reasons, abut 2/3 of the patients were from Surgical procedures.

Silicon Gel formulation was applier on average twice daily basis; in 83.6% of the cases no secondary treatments were instituted.

Methods:

Treatment efficacy was measured using typical scar symptoms, difference in color from surrounding skin, pliability and height, itchiness and pain/tenderness. The symptoms were evaluated using a 4-lvele scale (none, mild, moderate and severe), by patinets and physicians. Results were carried-out by comparing initial and final evaluation of the scar.

Tolerability was evaluated on the basis of adverse reactions and an estimation of relationship of these reactions to the product, and on the overall evaluation of the tolerability by both physician and patient at the end of the treatment.

Results:

Efficacy: Improvement of scar symptoms
70% to 84.2% of physicians reported improvement in the various scar symptoms. The evaluation by the patients was almost entirely consistent with the physicians’ evaluation (69.8% to 85.1%). The overall evaluations of effectiveness were also practically identical. 70% to 85% of physicians and patients rated improvement in scar symptoms as “good” or “very good”.

Tolerability

A total of 26 adverse reactions were observed in 23 of the 1522 patients (1.5%) who received the gel treatment. In the judgment of the treating physicians, 10 of the reactions were in a probable and 5 more in a possible causal relationship with the use of the product under study. In all cases, these adverse reactions were skin reactions, e.g. burning, redness, or itching. These symptoms are commonly associated side effects of keloid and hypertrophic scar treatment.

98.7% of Physicians and 98.2% of patients rated tolerability of the patented silicone formulation as “very good” or “good”.

Physician and Patient Satisfaction With The Patented Silicone Gel Formulation

Ease of use was evaluated positively by the physicians and the patients alike. The physicians also rated patient compliance very positively, followed by duration of treatment and cosmetic result.

Conclusion:

The observational study with 1522 patients of the use of Silicon Gel to treat scars demonstrates the good effectiveness of the product, as evidenced by the marked relief of scar symptoms. The product is highly tolerable in use, and both physicians and patients are satisfied with the product the therapeutic success achieved by its use.

Additional Studies:

Evolution of Silicone Therapy and Mechanism of Action in Scar Management

THOMAS A. MUSTOE

Click this link to view file: Pharmacy- SCARmed – Clinical Data Silicon Gel Set 2 – Low Res File

A Review of the Biologic Effects, Clinical Efficacy, and Safety of Silicone Elastomer Sheeting for Hypertrophic and Keloid Scar Treatment and Management

BRIAN BERMAN, MD, PHD, OLIVER A. PEREZ, MD, SAILESH KONDA, BS, BRUCE E. KOHUT, DMD,y MARTHA H. VIERA, MD, SUZETTE DELGADO, BS, DEBORAH ZELL, MD, AND QING LI, MD, PHDy

Click this link to view file: Pharmacy- SCARmed – Clinical Data Silicon Gel Set 1 -Low Res File

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