Study Focus: Moisturization is Very Important for Scar and Stretch Mark Repair

Two adjacent scars: one untreated and the other treated for two months with a silicone gel

We already know that keeping the skin moisturized ensures young, soft skin. Moisturizing is also important when it comes to improving the appearance of scars and stretch marks. An article in the December 2012 issue of the International Journal of Cosmetic Science reviews this very topic. 

How are skin cells in a scar different from skin cells in normal skin?

Some time ago, we thought that the stratum corneum (upper most layer of the skin) was just dead cells: the nucleus–void end result of skin cell proliferation, nothing more. How naïve we were!

It turns out that this outer most layer of skin cells has a unique structure and function: it keeps water in, and keeps microbes out; it’s the first line of defense against UV rays; it senses external temperature, humidity and pH. And this is just a very short, over-simplified list!

Sadly, however, skin cells in a scar or a stretch mark do not function properly, and the skin barrier function is damaged.

This means that these cells are less able to hold in water, that the skin in this area is dryer, and all the functions mentioned above are compromised.

Worrying about eliminating scars is not just a matter of vanity anymore; it’s a matter of restoring proper skin function.

One sentence in this review says it all: “Thus, the effects of moisturizers are complicated, they have more effects on the skin than simply hydrating it, they have pleotropic skin benefits and they are the ultimate vehicle of corneotherapy.”

After a wound in the skin heals, trans-epidermal water loss increases, and needs up to a year to go back to normal. When the skin senses that water is lost excessively, an inflammatory response is stimulated that leads to abnormal production of collagen in the newly healed skin, which facilitates scar formation.

Moisturizing the newly healed wound would prevent this excessive water loss, which would prevent the inflammatory response, and therefore lessens the chance of scar formation.

This review points out 2 important facts:

scar-silicone-treatment

A surgical scar treated for two months with silicone gel (from Aesthetic Plastic Surgery)

1 – Moisturizing plays a very important role in improving the appearance of scars.

2 – Moisturizing under occlusion offers even better improvement.

So, basically, regular creams and oils can help, but a better choice is a silicone gel or film: something that would keep the scar hydrated under occlusion for longer periods.

Of course, some scars just won’t improve. This could either be because of the nature of the scar or the difficulty of remaining compliant with the treatment. In those cases, other options can be explored for improving the appearance of the scar, such as cosmetic surgery or laser.

Thank you for reading!

Sources:

AV. Rawlings, S. Biefeldt, KJ. Lombard. A Review of the Effects of Moisturizers on the Appearance of Scars and Striae. International Journal of Cosmetic Science 2012; 34 (6): 519-24.

PM. Eias, JS. Wakefield. Skin Barrier Function. In: Nutrition for Healthy Skin. Springer 2011;  Part 1, Chapter 4: 36-41.

TA. Mustoe. Evolution of Silicone Therapy and Mechanism of Action in Scar Management. Aesthetic Plastic Surgery 2008; 32: 82-92.

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14 thoughts on “Study Focus: Moisturization is Very Important for Scar and Stretch Mark Repair

  1. Joe says:

    Great article, Dr. Taha – I am curious about how water loss in the skin triggers an inflammatory response that stimulates collagen production…..my instincts tell me someone – somewhere – will jump on this reaction as a potential anti-wrinkle treatment.

    Who knows?

    • Dr. Hanan Taha, M.D. says:

      @Joe

      Thank you so much!

      Well, wound healing is a pretty complex process. To simplify matters, there are 2 ways healing can go, either to form a scar (a raised scar, a depressed scar, or a keloid), or to form normal skin.

      Recent research shows that the direction this healing process goes depends greatly on the skin cells themselves: specifically, how hydrated they are, and how much water is lost through the skin. If the skin cells are dry and water is lost excessively, the healing process takes the direction of scar formation.

      Why? well, the skin is trying to protect itself. Instead of taking its time in forming new, healthy collagen, it hastens to speed up the healing process. The collagen formed is defective, poorly organized, and really isn’t as good as the healthy collagen, but the skin thinks “this will have to do, we are losing too much water”. This poorly organized collagen is the result of poor healing, and poor healing is the result of an inflammatory response to excessive water loss.

      When I say inflammatory response, I mean that there are signals going on between the cells and each other that result in the production of inflammatory mediators (cytokines), and these stimulate other cells to produce collagen, new skin cells and whatever else the skin needs to close that wound.

      I do help this explains it clearly. I do not want to get too technical, but if you have more questions, please let me know.

      As for wrinkle management: its already established that wrinkle development can be delayed by 2 very important things: sunscreen and moisturization :) Thank you for your question!

    • Dr. Hanan Taha, M.D. says:

      @Scatterbraintures

      Neat name :)

      There are ScarAway sheets and Mederma gel.

      Stretch marks are not scars; the way they are formed are very different from scars, the skin is not broken after all, and they are instead the result of excessive skin stretching in pregnancy or a growth spurt in puberty. However, according to this review, stretch marks are expected to respond the same way to moisturization as scars.

      However, I would not suggest that you go out and buy some silicone sheets. I would however encourage taking care of stretch marks when they first appear or if they are expected to appear. A newly pregnant lady can benefit from constantly moisturizing areas where stretch marks are expected to appear.

      Thank you!

  2. Lucas says:

    This is very interesting! It only applies to healing scars, not old ones, right? Would another occlusive substance, like petrolatum, work as well as the silicone gel?

    Thanks.

    • Dr. Hanan Taha, M.D. says:

      @Lucas Hello hello!
      Newer scars are the best candidates. The older the scar gets, the harder it becomes to treat with simple moisturizing. For an old scar, corticosteroid injections or laser might be an option. Those would require a visit to the dermatologist.

      Petrolatum would work nicely of course, but as the article mentions, “occlusion” improves the results even better. Petrolatum will require constant reapplication, while a silicone sheet would be applied twice a day and its effect would last 12 hours. Again the problem here would be with compliance: people find it bothersome enough having to apply a silicone sheet twice a day :)

      Thank you Lucas, always great to know you’ve read and commented!

  3. Lisa says:

    Dr. Taha, you are absolutely right that the transepidermal water loss issue seems to be the current theory behind abnormal scar formation. You may be interested to know that the 2002 International clinical recommendations on scar management (Mustoe TA et al. Plast Recon Surg 2002; 110:560-571) are in the process of being updated by a panel of doctors, including many of the original authors. One point of difference– Mederma is not a silicone gel. It is an onion extract product. The gel used in the top set of photos is Kelo-cote, and gel used in the lower set of photos was Dermatix Ultra

    (full disclosure-I currently work with the Kelo-cote brand)

    • Dr. Hanan Taha, M.D. says:

      @Lisa
      Hello!
      Yes its true about Mederma. It is interesting that in this review, the importance of the actual moisturizing under occlusion was ranked higher than what the ingredients added to that moisturizer were. Onion extract was one of the products mentioned in this review repeatedly.
      Thank you for reading and commenting.

    • Dr. Hanan Taha, M.D. says:

      @Tiffany Martin
      Hi there.

      Hmm, if you are asking about specific silicone ingredients, these can be polysiloxane, alkylmethyl silicone, cyclopentasiloxane, etc. There are more than 50 products in the market that contain silicone for the treatment of scars, from sheets to gels to sprays. These include Cica Care, Spectragel, ScarAway, and Strataderm.

    • Dr. Hanan Taha, M.D. says:

      @Tiffany Martin
      I haven’t come across studies that favor one silicone to the rest, but they all have the property of occlusion and maintaining moisture, which is what we are after. To that end, Mederma is also a good option. It is not a silicone based product but is recommended by many top dermatologists.

  4. Christopher says:

    Dr. Taha, what about acne scars? Will it diminish the appearance of these types of scars as well? The reason I ask is because a lot of people claim that silicone is very bad for people with acne.

    Cheers,
    Chris.

    • Dr. Hanan Taha, M.D. says:

      @Christopher

      That’s an excellent question. Acne scars need moisturizing and sun protection, just like any other wound. Silicone can help with acne scars if they are elevated, not the depressed ones.
      It is not a good idea to apply silicone sheets on skin with active acne, or any open wounds. The silicone irritate the skin, and will actually delay the healing process. So it is only used AFTER the wound closes.

      Thank you for reading and commenting.

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