Imma Perfetto
Cosmos science journalist
Australian researchers have evaluated which products commonly recommended for managing active scars are actually the most effective for patients with linear, widespread or keloid scarring.
Their surprising findings showed a common moisturiser by US brand Eucerin was most effective at hydrating and preventing trans epidermal water loss (TEWL). While pricier products like liquid silicone (Strataderm) and BioOil “performed poorly, with negligible effects on hydration and TEWL”.
“We tell recovering patients about the importance of massage, moisturising and using pressure garments,” says first author of the study Tanja Klotz, a PHD candidate at the University of Adelaide and an occupational therapist with the Royal Adelaide Hospital’s burns unit.
“There are evidence-based guidelines around best practice for massage and compression, but moisturiser is something that remains up to each clinician.
“We found that there was significant variability in the effectiveness of common moisturisers clinicians recommend for scar management.”
The findings, published in the journal Burns, in will help clinicians make more informed decisions.
Trans epidermal water loss (TEWL) is the process by which water evaporates from the surface of the skin. It happens naturally in normal, healthy skin but increases when the skin barrier is impaired by things like harsh skincare, environmental damage, wounds or scars.
This can lead to dehydration and increased scar activity.
Moisturisers improve the barrier function of the skin’s outermost layer, the stratum corneum. They often contain:
- Humectants, which hydrate the skin by attracting moisture.
- Emollients, which fill gaps in the lipid matrix of the stratum corneum to restore its structural integrity.
- And occlusives, which form a hydrophobic layer on top of the skin to lock moisture in.
The researchers recruited 30 participants with no pre-existing skin conditions to assess the performance of 8 moisturising products. This was done using a method which simulates the elevated TEWL of active scarring on the skin – ‘tape-stripping’.
“Adhesive films are pressed on the skin surface and then removed. This results in sequential removal of the stratum corneum of the epidermis producing acute barrier disruption, similar to that seen in scar tissue,” the authors explain in their paper.
“The number of strips or the amount of pressure applied determines how much of the stratum corneum is removed.”
Areas of skin were left unstripped to act as controls.
What they found was unexpected.
“Silicone gel sheets are widely used to manage scars and are made of a soft, flexible silicone material which is designed to provide a barrier against TEWL. The evidence base for the use of these is extensive,” says Klotz.
“We were surprised that the gel sheets had a high hydration level but also recorded a high TEWL due to all the hydration evaporating on removal, while a liquid silicone gel performed poorly for improving hydration and reducing TEWL.”
Eucarin Advanced Repair Cream, a mid-range product from the US, was identified as the most effective moisturiser which significantly increased hydration and normalised TEWL. It was followed by Redwin Sorbolene.
“Eucerin efficacy in increasing hydration can be attributed not only to its formulation as an oil-in-water emulsion but also to the presence of glycerine and urea [humectants] as the primary active ingredients after water,” says Klotz. The subsequent ingredients are mainly emollients.
QV Lotion, which has a similar composition to Sorbolene, did not perform as well iat normalising TEWL. The authors suggest this may be due to the presence of mineral oil which increases Sorbolene’s viscosity and may help it remain on the skin.
“In contrast, the products with the lowest hydration efficacy were Alhydran, Strataderm (a gel silicone) and BioOil which were the most expensive, and they all – besides Alhyrdran – showed limited ability to normalise TEWL,” says Klotz.
“These findings highlight that higher cost does not necessarily correlate with superior outcomes.”