A comparative study evaluating the tolerability and efficacy of two topical therapies for the treatment of keloids and hypertrophic scars. Hydration and occlusion treatment for hypertrophic scars and keloids. The effects of onion extract on hypertrophic and keloid scars. The Efficacy of Topical Silicone Gel Elastomers in the Treatment of Hypertrophic Scars, Keloid Scars, and Post–Laser Exfoliation Erythema The effect of topical scar treatment on postoperative scar pain and pruritus after total knee arthroplasty Efficacy of Contractubex gel in the treatment of fresh scars after thoracic surgery in children and adolescents. Possibilities of scar treatment after thoracic surgery. Safety and efficacy of local administration of contractubex to hypertrophic scars in comparison to corticosteroid treatment. Results of a multicenter, comparative epidemiological cohort study in Germany. Skin closure of laparotomy wounds: absorbable subcuticular sutures vs. non-absorbable interrupted sutures. Comparison of efficacy of silicone gel, silicone gel sheeting, and topical onion extract including heparin and allantoin for the treatment of postburn hypertrophic scars. A Randomized, Controlled Trial to Determine the Efficacy of Paper Tape in Preventing Hypertrophic Scar Formation in Surgical Incisions that Traverse Langer's Skin Tension Lines Use of Onion Extract, Heparin, Allantoin Gel in Prevention of Scarring in Chinese Patients Having Laser Removal of Tattoos: A Prospective Randomized Controlled Trial Effective symptomatic treatment for severe and intractable pruritus associated with severe burn-induced hypertrophic scars: A prospective, multicenter, controlled trial. What is the prevalence of hypertrophic scarring following burns? Successful Treatment of Earlobe Keloids with Imiquimod after Tangential Shave Excision Prophylactic Treatment of Deep Dermal Burn Scar to Prevent Hypertrophic Scarring Using the Pulsed Dye Laser: A Preliminary Study Scar Prevention Using Laser-Assisted Skin Healing (LASH) in Plastic Surgery Role of silicone derivative plus onion extract gel in presternal hypertrophic scar protection: a prospective randomized, double blinded, controlled trial. The effect of Hypericum perforatum on the wound healing and scar of cesarean. The effect of burn rehabilitation massage therapy on hypertrophic scar after burn: a randomized controlled trial.
BACKGROUND Onion extract gel ( OE ) and 0.5 % hydrocortisone , silicone and vitamin E lotion ( HSE ) are two over-the-counter preparations used to enhance the cosmesis of keloids and hypertrophic scars . OBJECTIVE To determine the tolerability and efficacy of OE versus HSE versus placebo in subjects with keloids and hypertrophic scars . METHODS Thirty subjects ( > or = 18 years ) with keloids or hypertrophic scars were r and omly assigned to one of three study preparations for 16 weeks . Scar volume was measured at baseline and weeks 4 , 8 , 12 and 16 . Subjects and blinded investigators assessed scar parameters ( in duration , erythema , pigmentation alteration , pain , itching , tenderness and cosmetic appearance ) and patient satisfaction at each visit using a visual analog scale ( VAS ) . Data analysis included : mean percentage change ( MPC ) for subjects completing the study ( n = 15 ) ; the mixed model test to determine differences between the groups over time ; and the Kruskal-Wallis test for the analysis of differences in subjects ' satisfaction within the three groups over 16 weeks for subjects who completed at least one follow-up visit ( n = 21 ) . RESULTS All three preparations were well tolerated with the exception of a mild acneiform-like eruption in one OE patient . Significant improvements were obtained with OE in volume , length , width and in duration and with  HSE in volume , length , in duration , erythema and pigmentation alteration . There was a trend showing that a higher percentage of subjects were satisfied with OE than with HSE or placebo . The Mix Model Analysis ( MMA ) showed significant improvements with OE over placebo in investigator cosmetic assessment , lesion in duration , pigmentation and tenderness and with  HSE  over placebo in investigator cosmetic assessment , lesion in duration , pigmentation and erythema . Improvements in erythema and pigmentation were significantly greater in HSE than in OE . CONCLUSION Both OE and HSE were more effective than placebo in the management of hypertrophic scars and keloids In 31 patients with hypertrophic scars or keloids , a side by side test was carried out to check the efficacy of an occlusive dressing technique using cream which did not contain silicone oil , versus a simple application of vaseline , used as a control . In all cases , the cream treated areas of scar and keloid demonstrated a remarkable improvement over that of the vaseline treated area . These findings strongly suggest that the mechanisms of hydration and occlusion are the main basis of the therapeutic action of this method in treating hypertrophic scars and keloids OBJECTIVE To evaluate the therapeutic activity of topical onion extract in gel form on  hypertrophic and keloid scars  , focusing on problems such as elevation , redness , hardness , itching and pain . METHOD This comparative prospect i ve study assigned 60 patients to three groups . Group I was treated with onion extract alone , group 2 with silicon gel sheet alone and 3 group with a combination of onion extract and silicon gel sheet . RESULTS In the group comparisons , a significant difference was observed at the end of six months in the colour parameter between group I and group 2 and in the height parameter between group I and group 3 ( ANOVA post-hoc Tukey 's test , p<0.01 and p<0.05 respectively ) . The onion extract was more effective in relation to scar colour , while the silicon gel sheet was superior in decreasing the height of scar ( paired sample t-test , p<0.001 ) . In addition , the most effective therapeutic results were obtained when the silicon gel sheet treatment was combined with onion extract in group 3 . CONCLUSION Onion extract improved hypertrophic and keloids scars via multiple mechanisms . However , it was statistically ineffective in improving scar height and itching . For this reason , onion extract therapy should be used in combination with an occlusive silicon dressing to achieve a satisfying decrease in scar height Background Dermatix is a Food and Drug Administration ( FDA ) -registered substantial equivalent to silicone gel sheeting for the prevention and management of hypertrophic scars and keloids . Methods A 90-day prospect i ve study evaluated the efficacy of Dermatix , silicone gel sheeting , and a combination of these treatments in improving scars for 30 patients . Each patient had a bilateral scar that served as an untreated control . The outcome measures included profilometry analysis of scar topography before and after punch biopsies of the control and treated scars , symptoms associated with the scars , and patient evaluations of the ease of treatment . Results The results showed better resolution and improvement of scars with Dermatix treatment or the combined use of Dermatix and silicone gel sheeting than with silicone gel sheeting alone .  Wound erythema was reduced , and collagen architectural reorientation was demonstrated histologically . Patients rated Dermatix as easier to use than silicone gel sheeting . Both Dermatix and silicone gel sheeting reduced symptoms of itching , irritation , and skin maceration . Conclusion The results of this study indicate that Dermatix is a useful treatment for the management of abnormal scarring Introduction The surgical wound of total knee arthroplasty ( TKA ) needs continuous flexion and extension movement . Silicone gel treatment is widely used to treat hypertrophic scars and keloids since it is easily applied and prevents scar pain and itching . The aim of this study was to evaluate the clinical efficacy and safety of silicone gel applied to surgical scars of TKA on postoperative scar pain and pruritus . Material s and methods One hundred TKAs were r and omized into a  silicone gel group ( silicone gel was applied to the wound after stitch-out for 1 month ) or a placebo group . The postoperative scar pain and pruritus were evaluated with the use of a visual analog scale ( VAS ) at postoperative 3 months , 6 months and 1 year . Scar assessment was done using the Vancouver scar scale by evaluating scar pigmentation , vascularity , pliability , and height . Results Although silicone gel group showed better pigmentation and height scales than placebo group ( P < 0.05 ) , there were no significant differences in the postoperative scar pain and pruritus VAS scores between the groups ( P > 0.05 ) . Conclusions Application of silicone gel had no beneficial effects on scar pain and itching relief during the early postoperative period of TKA.Level of evidence I-R and omized Controlled Scar development was investigated in 45 young patients who had undergone thoracic surgery . Patients were r and omly assigned either to a group which was treated topically with Contractubex gel ( Merz + Co. , D-Frankfurt/Main ) , containing 10 % onion extract , 50/U of sodium heparin per one g of gel and 1 % allantoin , or to a group receiving no treatment . The treatment began on average 26 days after the operation and was continued for one year . The scars of all treated and untreated patients were evaluated at monthly intervals . The appearance of the scar , including scar type and scar size as well as scar colour , was assessed by the physician . A reduction of the increase of scar width was seen in the Contractubex-treated group as compared with the untreated group . Further , physiological scars and skin-coloured scars were more frequent in the treated group than in the untreated group . Hypertrophic or keloidal scars were less frequent in the treated group . No differences in scar length and scar height were seen . At the end of the observation period , the clinical course of scar development was rated as " very good " or " good " in more than 90 % of the treated patients , " good " in less than 40 % and " moderate " or " bad " in more than 60 % of the untreated cases . The tolerability of the drug was " good " or " very good " in all cases . In conclusion , Contractubex gel is useful in scar treatment after thoracic surgery During a ten year observation period it was found that scar formation after thoracic surgery is influenced by various factors : metabolism , operative technique and factors of a general nature . On the basis of these findings , a study was carried out to investigate the effect of the scar-specific Contractubex gel ( Merz+Co . , D-Frankfurt/Main ) , containing 10 % onion extract , 50 U sodium heparin per g of gel and 1 % allantoin , in the treatment of children who underwent thoracic surgery and to evaluate its effect on scar development . Before and during the six-month treatment period , both macromorphology and scar colour were assessed ; furthermore , a global evaluation of the therapeutic result was made . Additionally , the scars were characterized after a six-month treatment-free follow-up period . The results of 38 Contractubex-treated and 27 untreated patients were compared . In the treated scars , the global evaluation of the therapeutic result was better than in the untreated scars . In the Contractubex group , the rating was " good " and " very good " in 84 % of cases , as compared to 59 % of the untreated cases . In the treated group , the increase in scar size was markedly lower than in the untreated patients . The treated scars showed a tendency towards quicker paling than the untreated scars . In the treated group , the conversion of primary physiological scars to unphysiological scars ( hypertrophic or keloidal scars ) was less frequent than in the untreated group . The tolerability of the product was very good in 37 of the 38 treated patients , and good in one patient . All scar-specific effects of Contractubex continued to persist after the end of treatment OBJECTIVES To investigate the safety and efficacy of Contractubex administration to  hypertrophic scars  in routine out-patient practice and to compare it to corticosteroid treatment . PATIENTS AND METHODS This was a multicenter , retrospective cohort study , based on 38 r and omly selected practice s representatively distributed in Germany , including dermatologists and general practitioners . Data from 859 patients fulfilling the inclusion criteria were assessed and analyzed . Of these , 771 patients were eligible for the per protocol treatment with Contractubex  ( n=555 ) and corticosteroid ( n=216 ) . The safety and efficacy of local administration of Contractubex to hypertrophic scars was compared to corticosteroid treatment . RESULTS At the end of defined treatment periods ( minimum 28 days for local therapy with 1 intralesional corticosteroid application ) , normalization of the pre-treatment pathological parameters ( erythema , pruritus , consistency ) of hypertrophic scars was more frequent ( 42.5 % ) after Contractubex per protocol treatment as compared to corticosteroid per protocol treatment ( 22.2 % ) . After adjusting imbalances of baseline characterisics between the treatment groups by the propensity score , the odds ratio was 2.274 , demonstrating a significant superiority ( p<0.001 ) of Contractubex treatment as compared to corticosteroid treatment . The time to normalization of erythema , pruritus and consistency was significantly ( p=0.034 ) shorter with Contractubex treatment ( median 344 days ) than with corticosteroids ( median 507 days ) . No unexpected or severe adverse events occurred in the Contractubex-treated patients . Apart from moderate pruritus ( 10 % Contractubex vs. 1 % corticosteroids ) , adverse events were significantly ( p<0.001 ) more frequent in  corticosteroid-treated patients ( teleangiectasias 15 % vs. 7 % Contractubex ; cutaneous atrophy of scars 10 % vs. 2 % Contractubex ; cutaneous atrophy of scar surrounding skin tissue 11 % vs. 1 % Contractubex ) . CONCLUSION For the primary aim of this study ( assessment of normalization of erythema , pruritus , and consistency of hypertrophic scars ) and for time to normalization , local administration of Contractubex was significantly more effective than corticosteroid treatment . Concerning safety , Contractubex treatment was associated with significantly less adverse events ( e.g. teleangiectasias , cutaneous atrophy of scars and surrounding skin tissue ) than topical corticosteroid application In a five year period ( 1984 - 1988 ) in the department of obstetrics and gynaecology of the University of Ilorin Teaching Hospital , Ilorin , 304 laparotomy patients whose skin incisions were closed with the traditional method of interrupted non-absorbable sutures or with absorbable subcuticular sutures were analysed . Out of these 304 patients , 164 had non-absorbable skin sutures  while 140 had  absorbable subcuticular sutures . The results of the two methods of skin closure were compared immediately on discharge , at 6 weeks and at 6 months after the operation . The appearance of the wounds and scar were better in the absorbable subcuticular group than in the non-absorbable interrupted group . The differences between the two groups were statistically significant in the cross-scar formation , Keloid/hypertrophic scar formation , period of hospitalisation and the acceptance rate . Subcuticular skin closure had the advantages of short stay in hospital , non stitch removal , better scar formation and being more acceptable to patients . There was no significant difference in the age between the two groups . All the patients were Africans We compared the efficacy of silicone gel ( Scarfade ) , silicone gel sheet ( Epi-Derm ) , and topical onion extract including heparin and allantoin ( Contractubex ) for the treatment of hypertrophic scars . Forty-five postburn scars were included in the study . Patients with scars less than 6 months from injury were assigned at r and om to three groups each containing 15 scars , and their treatment was continued for 6 months . Scars were treated with Scarfade , Epiderm and Contractubex .  Scar assessment was performed at the beginning of the treatment , and at the end of the sixth month when the treatment was completed by using the Vancouver scar scale . The difference between before and after treatment scores for each three groups was statistically significant . The difference between Scarfade group and Epi-Derm group was not significant ; however , the differences of the other groups ( Scarfade-Contractubex , Epiderm-Contractubex ) were significant . Silicone products , either in gel or sheet , are superior to Contractubex in the treatment of the hypertrophic scar . The therapist should select the most appropriate agent according to the patient 's need and guidelines of these signs Background : How a scar is managed postoperatively influences its cosmetic outcome . After suture removal , scars are susceptible to skin tension , which may be the trigger for hypertrophic scarring . Paper tape to support the scar may reduce multidirectional forces and prevent hypertrophic scarring . Methods : Seventy patients who had undergone cesarean section at the Royal Brisbane and Women 's Hospital were r and omized to treatment and control groups . Patients in the control group received no postoperative intervention . Patients in the treatment group applied paper tape to their scars for 12 weeks . Scars were assessed at 6 weeks , 12 weeks , and 6 months after surgery using ultrasound to measure intradermal scar volume . Scars were also assessed using the International Clinical Recommendations . Results : Paper tape significantly decreased scar volume by a mean of 0.16 cm3 , ( 95 percent confidence interval , 0.00 to 0.29 cm3 ) . At 12 weeks after surgery , 41 percent of the control group developed hypertrophic scars compared with none in the treatment group ( exact test , p = 0.003 ) . In the treatment group , one patient developed a hypertrophic scar and four developed stretched scars only after the tape was removed . The odds of developing a hypertrophic scar were 13.6 times greater in the control than in the treatment group ( 95 percent confidence interval , 3.6 to 66.9 ) . Of the 70 patients r and omized , 39 completed the study . Four patients in the treatment group developed a localized red rash beneath the tape . These reactions were minor and transient and resolved without medical intervention . Conclusions : The development of hypertrophic and stretched scars in the treatment group only after the tape was removed suggests that tension acting on a scar is the trigger for hypertrophic scarring . Paper tape is likely to be an effective modality for the prevention of hypertrophic scarring through its ability to eliminate scar tension BACKGROUND With rapid advancement in cutaneous laser therapy , Q-switched lasers have become the st and ard treatment for tattoo removal . The longer wavelength Q-switched Nd : YAG laser is used when removing tattoos in darker skin patients to avoid scarring and permanent pigment changes . Nevertheless , the local experience revealed that nearly 25 % of the Chinese patients developed scarring . Meanwhile , multiple clinical studies have shown that Contractubex gel ( Merz Pharma , Frankfurt , Germany ) was effective in the treatment and prevention of hypertrophic scars and keloids . OBJECTIVE To evaluate the efficacy of Contractubex gel in the prevention of scarring after laser removal of tattoos in Chinese patients . METHODS A total of 120 Chinese patients with 144 professional blue-black tattoos were recruited into the study . They were r and omly assigned into the Contractubex group or the control group . All patients were treated with a QS 1,064-nm Nd : YAG laser using a 3-mm spot size , a 10-Hz repeat rate , a pulse duration of 6 nanoseconds , and fluences that ranged from 3.6 to 4.8 J/cm2 ( mean fluence , 4.2 J/cm2 ) . The treated areas were assessed 3 months after the last treatments for clinical clearance and complications . RESULTS Fifty-two patients with 61 tattoos in the Contractubex group were able to achieve a mean clearing rate of 82.3±11.6 % . There were 7 tattoos in 7 patients that developed scarring , 4 patients had permanent hypopigmentation , and 3 patients had transient hyperpigmentation . In contrast , 55 patients with 68 tattoos in the control group had a mean clearing rate of 80.4±11.3 % . Among them , 16 tattoos in 14 patients developed scarring , 4 patients had permanent hypopigmentation , and 5 patients had transient hyperpigmentation . Although there was no significant difference in age , sex , fluence , treatment session , and clinical clearance between the two groups , the Contractubex group had a statistically significantly lower rate of scarring than the control group ( p<.05 ) . CONCLUSION Contractubex gel is effective in scar prevention in Chinese patients having laser removal of tattoos BACKGROUND Burn-induced hypertrophic scars are disfiguring and can be associated with severe and intractable pruritus . No effective treatment modalities are currently available for symptomatic control of pruritus for most patients . We assessed the effect of the Antipruritic Hydrogel ( CQ-01 ) in the symptomatic treatment of severe and intractable pruritus associated with burn-induced hypertrophic scars in a prospect i ve , multicenter , controlled trial . METHODS A pilot study was conducted in healthy adult volunteers to identify the most appropriate hydrogel formulation . A selected preparation called Chongqing No. 1 ( CQ-01 ; a guar gum-based hydrogel impregnated with peppermint oil , menthol , and methyl salicylate by a nanoemulsion ) , showed an excellent symptomatic relief in an exploratory study in 2 patients with intractable pruritus . A statistically powered , prospect i ve , multicenter , controlled study was then conducted in 74 patients to evaluate the efficacy and safety of a 24-h application of CQ-01 compared to a gel control and a negative control on three separate areas in each patient . Symptom assessment was based on our visual analog JW scale ( ranging from 0 to 100 ) at baseline and various time points up to 7 days after application . Follow-up studies were conducted to determine the reproducibility of CQ-01 in repeated applications . RESULTS Of the 74 enrolled subjects , the only observed adverse event was skin irritation reported in 6 patients ( 8 % ) and resolved shortly after gel removal . Compared to the baseline , the gauze negative control had a mean JW score reduction of 7 ; while the gel control and CQ-01 had a drop of 18 ( p<0.001 ) and 36 ( p<0.001 ) , respectively . The CQ-01 clinical effect was significant for up to 3 days and waned slowly from 3 to 7 days . There was no statistical correlation between the treatment response and any of the demographic , patient or burn-related factors . Further studies showed a trend that repeated applications might be more effective , suggesting the absence of tachyphylaxis . CONCLUSIONS This prospect i ve , multicenter , controlled study showed that this novel hydrogel CQ-01 is safe and provides significant symptomatic relief for severe and intractable pruritus associated with hypertrophic scars , an unmet medical need for these patients . This effect is independent of the etiology of the burn trauma , extent of the scarring , and duration of the scar formation Hypertrophic scarring  after burns remains a major problem and is considered to be " common " . Pressure garments are commonly used as treatment even though there is little sound data that they reduce the prevalence or magnitude of the scarring . In 1999 we began a study of the efficacy of pressure garments on forearm burns .  After study ing 30 patients , mainly white adults , we found no hypertrophic scar in either those treated with pressure or without . This prompted us to review the literature on the prevalence of hypertrophic scarring after burns and found only four articles with a relatively small number of patients and only three geographical locations . It became clear that the prevalence of hypertrophic scarring is really unknown . We then did a retrospective study of 110 burn survivors and counted all hypertrophic scars of all sizes and locations in all races and found the prevalence hypertrophic scarring to be 67 % which conflicts with the published reports and our prospect i ve study and suggests that further research is necessary . We concluded that a worldwide , prospect i ve survey is necessary to establish the prevalence of hypertrophic scarring after burns . In this article we are calling for and offering to organize this survey BACKGROUND The treatment of earlobe keloids has historically been suboptimal ; characterized by discomfort , poor response , and high rates of recurrence . Keloids are characterized by increased fibroblast activity in the setting of an altered cytokine profile . OBJECTIVE To investigate whether topical imiquimod 5 % cream applied postoperatively after tangential excision can prevent recurrence of earlobe keloids . METHODS AND MATERIAL S Four patients with a total of eight large pedunculated earlobe keloids ( five of which were recurrent lesions ) were treated with debulking by tangential shave excision followed by daily application of imiquimod 5 % cream for 6 weeks . RESULTS At 6 and 12 months post-treatment there was an excellent cosmetic result and no evidence of recurrence in any of the lesions . Patients with keloids that were itchy and painful  were completely asymptomatic at the conclusion of the study . CONCLUSION In this pilot study , imiquimod 5 % cream following tangential shave excision was efficacious for the treatment of earlobe keloids . Further study is warranted to confirm the utility of imiquimod 5 % cream in the treatment of earlobe keloids , as illustrated herein The pulsed dye laser , by selectively targeting blood vessels , has been used to treat established hypertrophic scars with good effect . This prospect i ve clinical study aims to assess the feasibility of treating deep dermal burn wounds prophylactically before the formation of hypertrophic scars . Patients with burn wounds that took longer than 2 weeks to heal were primarily recruited . Each patient 's burn area was divided into a treated area and a negative control . The area was laser treated with the pulsed dye laser ( Chromos 585 ; SLS , Wales ) twice at 6 weekly intervals . The appearance of the wound at both sites was inspected visually and scored at 6 weeks , and at 3 , 6 , and 9 months . Five patients with six burn sites ( forearm , arm , and back ) were treated . Treated areas achieved better scarring at 6 weeks ( p = 0.04 , paired t-test ) and at 3 months ( p = 0.003 , paired t-test ) . The difference , however , became insignificant at 6 and 9 months . No notable side effects were seen in all patients . Prophylactic treatment of burn wounds with the pulsed dye laser is effective in hastening the resolution of scarring . In the authors ’ opinion , this treatment may revolutionize the traditional method of hypertrophic burn scar prevention , and should be considered early , especially for patients who are prone to hypertrophic scarring , and in areas where hypertrophic scarring are common Background The use of lasers has been proposed for scar revision . A recent pilot clinical study demonstrated that lasers could also be used immediately after surgery to reduce the appearance of scars . The LASH ( Laser-Assisted Skin Healing ) technique induces a temperature elevation in the skin which modifies the wound-healing process . We report a prospect i ve comparative clinical trial aim ed at evaluating an 810-nm diode-laser system to accelerate and improve the healing process in surgical scars immediately after skin closure . Methods Twenty-nine women and 1 man ( mean age = 41.4 years ; Fitzpatrick skin types I-IV ) were included to evaluate the safety and performance of the laser system . The laser dose ( or fluence in J/cm² ) was selected as a function of phototype and skin thickness . Each surgical incision ( e.g. , abdominoplasty ) was divided into two parts . An 8-cm segment was treated with the laser immediately after skin closure . A separate 8-cm segment was left untreated as a control . Clinical evaluations ( overall appearance ratings , comparative scar scale ) of all scars were conducted at 10 days , 3 months , and 12 months by both surgeon and patients . Profilometry analysis from silicone replicas of the skin was done at 12 months . Wilcoxon signed-rank test analyses were performed . Results Twenty-two patients were treated using a high dose ( 80–130 J/cm² ) and 8 patients with a low dose ( < 80 J/cm² ) . At 12 months in the high-dose group , both surgeon and patients reported an improvement rate of the laser-treated segment over the control area of 72.73 and 59.10 % , respectively . For these patients , profilometry results showed a decrease in scar height of 38.1 % ( p = 0.027 ) at 12 months for the laser-treated segment versus control . Three patients treated with higher doses ( > 115 J/cm² ) experienced superficial burns on the laser-treated segment , which resolved in about 5–7 days . For the eight patients treated at low dosage ( < 80 J/cm² ) , there was no significant difference in the treated segment versus the control segment . No side effects were observed . Conclusion This prospect i ve comparative trial demonstrates that an 810-nm diode laser treatment , performed immediately after surgery , can improve the appearance of a surgical scar . The dose plays a great role in scar improvement and must be well controlled . There is interest in LASH for hypertrophic scar revision . LASH can be used to prevent and reduce scars in plastic surgery Use of silicone derivative and onion extract had been reported in the prevention of hypertrophic scarring . Our experience showed the preventive use of silicone derivative plus onion extract gel on hypertrophic scars after median sternotomy . In a r and omized , double blinded , placebo-controlled study , 60 patients after median sternotomy incisions were separated into two groups . All patients were treated either with silicone derivative plus onion extract gel ( Cybele ( ® ) scagel ) or placebo gel twice daily for a total treatment period of 12 weeks . During each visit , pain and itching scores were grade d by the patients and scar characteristics were observed by surgeons using the Vancouver scar scale . Pain and itch score values from patients ' who applied silicone derivative plus onion extract gel was less than another group ( P < 0·05 ) . Pigmentation was significantly different between two groups ( P < 0·05 ) and the reduction of scores on vascularity , pliability , height in treated group was not superior to the untreated group . No adverse events were reported by any of the patients . A silicone derivative plus onion extract gel is safe and effective for the preventing the hypertrophic scarring after median sternotomy OBJECTIVE The aim of this study was to determine the effects of Hypericum perforatum on  cesarean wound healing and hypertrophic scar .  DESIGN This was a r and omized , double-blind clinical trial study . SETTING The study was conducted in Samen-Ol-Aemmeh ( Pbuh ) Hospital in Mashhad , Iran . SUBJECTS The subjects included 144 women with surgical childbirth who had eligible criteria . INTERVENTION The participants were r and omly assigned to three groups . The treatment and placebo groups applied H. perforatum or placebo ointment 3 times a day for 16 days based on consecutive coded ointments . The control group remained without any intervention postoperatively . ASSESSMENT Wound healing was assessed on the 10th day postcesarean using the REEDA scale ( REEDA st and s for redness , edema , ecchymosis , discharge , and approximation ) , which had criteria including redness , edema , ecchymosis , discharge , and approximation . On the 40th day , the degree of scarring was assessed using the Vancouver scar scale including pigmentation , height , pliability , and vascularity . The subjects were also asked some questions about pain by using the Visual Analogue Scale and pruritus of scar . RESULTS The mean age of all the study subjects was 23.50 + /- 4.03 and mean parity was 1.23 + /- 0.48 . There were significant differences in wound healing on the 10th day ( p < 0.005 ) and scar formation on the 40th day postpartum ( p < 0.0001 ) between treatment group with placebo and control groups . However , the placebo group had no differences in wound healing ( p = 0.93 ) and scar formation ( p = 0.11 ) with the control group . In addition , significantly lower pain and pruritus were reported by the treatment group compared with the placebo and control groups on the 40th day postpartum . CONCLUSIONS Topical application of H. perforatum is safe and can facilitate cesarean wound healing and minimize formation of scar and its pain and pruritus OBJECTIVE To evaluate the effect of burn rehabilitation massage therapy on hypertrophic scar after burn . METHOD One hundred and forty-six burn patients with hypertrophic scar(s ) were r and omly divided into an experimental group and a control group . All patients received st and ard rehabilitation therapy for hypertrophic scars and 76 patients ( massage group ) additionally received burn scar rehabilitation massage therapy .  Both before and after the treatment , we determined the scores of visual analog scale ( VAS ) and itching scale and assessed the scar characteristics of thickness , melanin , erythema , transepidermal water loss ( TEWL ) , sebum , and elasticity by using ultrasonography , Mexameter ( ® ) , Tewameter ( ® ) , Sebumeter ( ® ) , and Cutometer ( ® ) , respectively . RESULTS The scores of both VAS and itching scale decreased significantly in both groups , indicating a significant intragroup difference . With regard to the scar characteristics , the massage group showed a significant decrease after treatment in scar thickness , melanin , erythema , TEWL and a significant intergroup difference . In terms of scar elasticity , a significant intergroup difference was noted in immediate distension and gross skin elasticity , while the massage group significant improvement in skin distensibility , immediate distension , immediate retraction , and delayed distension . CONCLUSION Our results suggest that burn rehabilitation massage therapy is effective in improving pain , pruritus , and scar characteristics in hypertrophic scars after burn
Contractubex showed best results in the prevention of pathological scars .
BACKGROUND The treatment and prevention of  hypertrophic scars and keloids  represents a special challenge particularly in plastic surgery .
Given their simple , non-invasive and painless application , topical preparations are an attractive therapeutic option .
On the part of the patients , the efficacy in prevention of and therapy for hypertrophic scars and keloids of these topical preparations is regularly question ed .
The clarification of this issue is subject of this review .