Scar treatment and prevention with silicone

An “evidence-based approach in scar management ... highlights a primary role for silicone gel ... in the management of a wide variety of abnormal scars.” [1]

• In a 27-trial meta-analysis and results from 8 randomised controlled trials, silicone gel proven safe and effective for hypertrophic scars and keloids
• Best practice, in many cases, involves the use of less radical therapy early on for both treatment and prevention
• Silicone is the only non-invasive option for which evidence-based recommendations have been made for both scar treatment and prevention
• Silicone is recommended as first line therapy in the treatment of:
• Linear hypertrophic scars
• Keloids
• Widespread burn hypertrophic scar
• Silicone gel can be used as mono-therapy or in combination with other therapies

Scar treatment/remodelling

The 2002 International Clinical Recommendations on Scar Management highlight a primary role for silicone gel and intralesional corticosteroids [1]

Scar type
Immature hypertrophic	Linear hypertrophic (surgical/traumatic) scar	Minor keloid	Major high risk keloid	Widespread burn hypertrophic scar
Initial management
Apply prevention algorithm. Treat as a hypertrophic scar if erythema continues for >1 month	Silicone gel sheeting (2 months) Monthly steroid injections			Speciality burns unit
		Localised pressure therapy if possible (3–12 months)
	Secondary management
	Pressure therapy	Laser therapy Surgery with adjunctive silicone gel sheeting (2 months)		Pressure garments +/- silicone gel sheeting (6–12 months)
	Unit specialising in scar therapy Combination/monotherapy: Primary: steroids, silicones, pressure therapy, surgery/grafting Occasionally: cryotherapy, radiotherapy, laser, other therapies

Abnormal scar prevention

For abnormal scar prevention, silicone should be considered as first-line prophylaxis, beginning shortly after surgical closure [1]

	Surgery or trauma Good surgical technique and wound management reduce the risk of scarring
Risk of scarring
High risk	Increased risk	Low risk
	Hypoallergenic taping or ...	Patient concerned?
		Yes	No
... silicone gel sheeting			Standard counselling