Here’s a fact: newborn babies who undergo surgery in the womb heal without any scarring. And scientists are close to figuring out how to replicate this type of regeneration outside of the womb.
The scar treatment global market is valued at roughly $18B in 2018. Treating scars is more than a vanity project. Certain types of scars can continue to grow and itch. And scar visibility can cause psychological stress. Although aggressive treatments such as surgery, steroid injection, laser, and prescription topical treatment are available, it has never been easier to purchase over-the-counter solutions. These mostly consists of silicone gels. So we ask: how effective are silicone gels based on research? And what is the future of scar treatment and management?
To answer simply, yes, research shows that silicone works in terms of decreasing color, texture, and height of scars. They also relieve subjects of itching and discomfort. But we currently still have limited data and more work needs to be done. And in the future, we might not even scar at all!
Why Do We Scar?
We scar when our body heals. Tissues break when wounded, and our body releases collagen (a protein) to heal the wound. The increased blood supply causes the bump and changes in texture.
Research on silicone sheet and gel scar treatment generally look at two types of scars: keloids and hypertrophic scars.
Keloids: an extreme type of scarring, wherein the scar tissue forms beyond the original wound.
Hypertrophic: these scars do not extend beyond the original wound, but are raised. They form in parts of our bodies where skin is taut such as “shoulders, ankles, knees, and the neck”.
Silicone, Silica, and Silicon: Not the Same
A common misconception is that silicone gel is made of silica or silicon. This is not the case. Silica and silicon are natural occurring chemicals and minerals. On the other hand, silicone is a synthetic polymer.
On Effectiveness and Adverse Effects
A study published by Cutis, showed that 56% of participants saw improvement in chronic scars if participants wore gel sheets for 2 months for at least 12 hours per day. In another study, keloids decreased by as much as 30% if participants had sheets for 24 hours a day consistently for 2 months. A 2016 study published in The Journal of Clinical and Aesthetic Dermatology shows that the silicone “test product improved the appearance of scars after three months of treatment and with no adverse events”.
Note that existing studies have low sample sizes. More evidence-based research will certainly help strengthen findings.
How Do they Work?
There seems to be a debate on the various ways silicone can treats scars, but the main function involves controlling collagen production. Silicone prevents the over production of collagen by hydrating the wound, inhibiting certain proteins, specifically cytokines, and reducing blood supply to the scar.
The Future: What If We Don’t Scar At All?
Researchers from Stanford, working on scar prevention and functional tissue regeneration, uncovered how a type of connective tissue cell in the skin called the fibroblast causes scarring. It does so by activating a gene called Engrailed-1. In their experiment, growing mouse fibroblast cells on stress-free gel inhibited the scar-associated gene.
Another finding involves the activation of a protein called Yes-association protein (YAP) during scar formation. When researchers blocked the YAP, “skin healed more slowly but without any hint of scar.” To block the protein, researchers used an existing drug for the eyes.
The process essentially mimics fetal skin cells, which can heal without leaving marks.
Note that these early-stage trials involve mice but research is moving on to mammals.