Main Issue August 2011

Therapeutics Q&A: Topical Treatment for General Scarring: Hype and Realities

Few topical scar therapies have been well studied, but onion extract has shown in controlled trials to be effective.

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Though there is generally little that can be done to treat them in the clinic, small to medium scars secondary to injuries, scrapes, and burns are common. While patients may not present to the clinic specifically for advice on scars, they may at least seek treatment advice from their physicians. Individuals often seek topical aid to lessen the appearance of scars or hasten their healing. However, despite the bevy of topical products now marketed for scar treatment, effective agents are rare. Ahead, Alan B. Fleischer, Jr., MD, Professor Dermatology at Wake Forest Baptist Medical Center in Winston-Salem, NC and Executive Director of Dermatology at Merz USA, shares insights on scarring in dermatology and the role of one particular agent that has shown efficacy in controlled trials.

Can you share your impressions of the field of OTC agents for the treatment of general scarring?
According to Dr. Fleischer, a large number of products available for scarring aid have not been studied or shown to provide any real benefit. “Essentially, most of these cosmetic products are whipped up in a lab and then put on the market with fancy packaging,” says Dr. Fleischer. “Topical agents for scarring represents a general area that lacks scientific rigor in the evaluation of products,” he continues.

The general lack of soundly tested products may reflect a general disinterested attitude toward scarring in medical practice. However, Dr. Fleischer says, “the common nature of scarring and the proliferation of products indicates that the appearance of scars is of some cosmetic importance to the public.”

Despite an overall lack of studied formulations, one agent, has been shown in controlled trials to be beneficial for general scarring, including stretch marks, notes Dr. Fleischer. Onion extract gel (Mederma, Merz) has been clinically tested and shown to be effective in reducing the appearance of scars, he observes. “The evidence indicated that onion extract gel is effective in a majority of patients after eight weeks of daily application,” says Dr. Fleischer. Roughly three out of every four patients receiving Mederma [Scar] Gel in one trial showed quite significant improvements, with scars being significantly softer and less noticeable, adds Dr. Fleischer.

How significant a role can onion extract play in the treatment of scars?

There appears to be some bias against botanical products as useful agents in therapy because many of these products lack strong scientific inquiry, according to Dr. Fleischer. “However, botanical agents can have true therapeutic value, as a fair number of pharmacologic formulations incorporate botanical elements,” says Dr. Fleischer. The strong clinical outcomes for Mederma Scar Gel in clinical trials lend credence to this fact.

While onion extract may not be the solution for deeper and hypertrophic scars, it can be beneficial as an adjunct to other treatments, as well, Dr. Fleischer observes.

The ability to treat their scars topically can have practical benefits for patients. “Another component of a clinically proven topical agent such as Mederma is that it allows patients to participate in the process of their care,” says Dr. Fleischer. Certainly, using a product with some clinical evaluation increases the likelihood of positive outcomes, but it also may allow patients to feel like they are playing an active part in the healing of their scar. This, according to Dr. Fleischer, may increase adherence.

In order for patients to see the effects off the product, they will need to apply it for eight weeks, which can be a long time for patients. But according to Dr. Fleischer, it’s important to note that the duration of the wound healing process takes well in excess of a year. “Therefore, empowering patients and/or the general public to be part of the process gives them a useful activity while they’re watching the process,” says Dr. Fleischer. He adds, “Compliance in daily application can influence the result to optimize scar appearance. Patients should be involved and committed to treating the scar and realize that it is not a ‘quick fix’ remedy.”

There is also a related product for stretch marks. What is the evidence behind it and what are its potential applications?

According to Dr. Fleischer, Mederma Stretch Marks Therapy (Merz, based on the same onion extract as Mederma) has shown to be equally beneficial as the scarring product in reducing discoloration and significantly decreasing the appearance of stretch marks. “One particular controlled trial indicated clearly that those on the Mederma Stretch Marks Therapy side were significantly improved, as compared to the side not using Mederma Stretch Marks Therapy,” says Dr. Fleischer.

Although Stretch Marks Therapy is most commonly used in pregnant women, Dr. Fleischer explains that it can also be generalized to a pediatric population. “Particularly in the teen population, Mederma’s Stretch Marks Therapy can be beneficial for those whose body tissue outstretches the skin’s ability to keep up,” he says. When this happens, often a controlled tear in the form of a bright red stretch mark will occur. While pregnant women in some ways may anticipate stretch marks, teens tend to be more surprised when stretch marks appear on their skin, Dr. Fleischer observes.

However, as with pregnant women, teenagers will not likely visit a physician primarily to have their stretch marks assessed and treated. “It’s relatively uncommon for people to present solely because of their stretch marks,” says Dr. Fleischer. “But that doesn’t lessen the concern that many teens and pregnant or formerly pregnant women have regarding how to best address these scars and stretch marks,” he continues. Dr. Fleischer recommends that physicians maintain an awareness of stretch marks and other scars and the wide populations they affect and be prepared to discuss treatment options with patients.

Can you offer a take-home message regarding the topical treatment of scarring?

According to Dr. Fleischer, sales and recommendations of Mederma are not just based upon a few anecdotes but instead on large numbers of people who have undergone trials for scars in rigorous fashion. “The trials for this product clearly show that it makes a significant difference compared to not using it,” he observes.

“If you are going to spend eight weeks using a product, it should be a product that does offer demonstrated efficacy,” says Dr. Fleischer. The challenge, then, is to ensure that consumers are informed about these facts and that they do adhere to regular treatment application schedules.

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