Skin is an important barrier that protects the body from outside elements. After ones skin breaks, the body starts to heal itself. During the healing process, the body may not produce the exact epidermal layer as before, resulting in scars that can become upsetting and unsightly. Preventing and treating scar tissue formation is best done by limiting physical/chemical trauma or infections which cause inflammatory reactions that increase the prevalence of scars.1
Many OTC scar treatments are classified as cosmetics. If the product were to be classified as a drug, data is needed to show that the product is both safe and effective. Cosmetics on the other hand are not required to register with the FDA, and do not need safety or efficacy data. Therefore, it is common for manufacturers to claim that cosmetic results vary by individual, making the company not responsible for an ineffective product.2
Vitamin E ointment is an oil based agent that has antioxidant capabilities. Research has shown that the topical application of Vitamin E is no more effective at treating scars than non-medicated emollient type ointments (Aquaphor). Vitamin E ointment may also irritate the skin more than Aquaphor.1,2 With the current literature review, Vitamin E ointment does not appear to be effective in treating the appearance of scars.
Mederma is a popular ointment consisting of onion extract as its active ingredient (Allium cepa) which is thought to provide anti-proliferative and anti-inflammatory effects. Research has not found significant differences in scar appearance after 12 weeks of post-op application when comparing Mederma and Aquaphor.3 Further studies have shown that onion extract gel is no more effective than petrolatum (Vaseline) at treating redness and itching.4,5 Additionally, most studies conducted using Mederma are poorly designed and have not shown positive results relating to scar treatment.1 Therefore, until further well conducted studies are available, Mederma should not be considered an effective product.
Silicone may help in scar reduction by keeping the tissue moist, modulating growth factors, and increasing a static charge.2,6 A benefit to silicone is that it has very few side effects and can be used for up to 12 hours per day for 3-6 months.7 Individuals at a high risk of developing abnormal scars may be treated with silicone gel sheets (Neosporin Scar Solution Silicone Scar Sheets, Scar FX Silicone Sheet, Dr Blaine’s Complete Scar Care Treatment) or silicone gels (2nd Skin Scar Gel) as research indicates that their use reduces scarring.2 Limited information indicates the efficacy of silicone sheets in decreasing the appearance of scars, therefore additional research is needed to confirm this treatment option.
Mechanical pressure (compression of the scar site) has been shown to decrease the production of scars.1 Although some clinicians question the practice of mechanical pressure, research to determine the effectiveness of this procedure is unethical as it would withhold accepted treatment from control subjects and will subsequently not be conducted.6 Therefore mechanical pressure will continue to be used until proven ineffective.
MEBO (Moist exposed burn ointment)
MEBO (moist exposed burn ointment) is a Chinese herbal compound that also contains sesame oil and beeswax. MEBO is very oily compound that has a strong odor. Studies have found that the administration of MEBO decreases scaring and redness.1,8 One study found that those with partial thickness skin grafts, when treated with MEBO, had significantly better scar quality and wound healing compared to Tegaderm, topical antibiotic ointment, and Sofra-Tulle dressing.8 Another study compared MEBO and silver sulfadiazine administration in burn victims. The results found similar healing rates with easier visibility to the healing process in MEBO than the opaque silver sulfadiazine. Although MEBO is less expensive than silver sulfadiazine, MEBO needs to be applied more often, increasing labor costs.9 Additional research continues to show that MEBO decreases treatment time and reduces infection risk (consequently decreasing scar risk). 10 MEBO is safe and effective in pregnant women and infants.11 MEBO should be applied every 4-6 hours to exposed wounds or every 10-12 hours for covered wounds.11 Therefore, research indicates that MEBO is effective, but additional studies are needed to solidify this data.
In conclusion, it appears that Vitamin E ointment and Mederma are not effective in treating the appearance of scars. Most studies find that Vitamin E ointment and Mederma have equivalent treatment outcomes compared to Aquaphor, with Aquaphor costing significantly less. After surgery, mechanical pressure at the surgical site is the standard of care to decrease scar tissue formation. This will continue to be the standard of care until proven otherwise. Silicone may eventually prove to be effective in scar treatment but additional research is needed for this to occur. MEBO does appear to be effective at decreasing scar appearance. Additional research needs to be conducted on MEBO to include it in standard of care guidelines for treating and preventing scars. In conclusion, additional research needs to be conducted on all treatments in order to determine what the appropriate standard of care should be when treating and preventing scars.
- Chen MA and Davidson TM. Scar Management: Prevention and Treatment Strategies. Current Opinion in Otolaryngology & Head and Neck Surgery. 2005. 13:242-247.
- Morganroth P, Wilmot AC, Miller C. Over-the-Counter Scar Products for Postsurgical Patients: Disparities Between Online Advertised Benefits and Evidence Regarding Efficacy. Journal of the American Academy of Dermatology. 2009. 61:e31-47.
- Chung VQ, Kelley L, Marra D, Jiang SB. Onion Extract Gel Versus Petrolatum Emollient on New Surgical Scars: a Prospective Double-Blinded Study. Dermatologic Surgery. 2006. 32:193–197.
- Jackson BA and Shelton AJ. Pilot Study Evaluating Topical Onion Extract as Treatment for Postsurgical Scars. Dermatologic Surgery. 1999. 25: 267–269.
- Saulis AS, Mogford JH, Mustoe TA. Effect of Mederma on Scarring in the Rabbit Ear Model. Plastic and Reconstructive Surgery. 2002. 110;1:177-183.
- Shih R, Waltzman J, Evans GRD. Review of Over-the-Counter Topical Scar Treatment Products. Plastic and Reconstructive Surgery. 2007. 119;3:1091-1095.
- Mutalik S. Treatment of Keloids and Hypertrophic Scars. Indian Journal of Dermatology Venereol Leprol. 2005. 71:3-8.
- Atiyeh BS, Amm CA, El Musa KA. Improved Scar Quality Following Primary and Secondary Healing of Cutaneous Wounds. Aesthetic Plastic Surgery. 27;5:411-417.
- Ang ES, Lee ST, Gan CS, See P, Chan YH, Ng LH, Machin D. The role of alternative therapy in the management of partial thickness burns of the face–experience with the use of moist exposed burn ointment (MEBO) compared with silver sulphadiazine. Ann Acad Med Singapore. 2002. 29(1): 7-10.
- Al-Numairy, Ali. Clinical Use of MEBO in Wounds Management in U.A.E. International Journal of Cosmetic Surgery & Aesthetic Dermatology. 2000. 2;1:27-33.
- Wound Healing- MEBO. Sekunjalo Health Care. [2010-2012}. 10/14/2012. http://www.sekhealth.com/Wound_Healing.aspx.