Evidence, not cost, should guide moisturiser choice in scar management, say Aussie researchers.
A recent study conducted by researchers at the University of Adelaide and the Royal Adelaide Hospital has revealed significant differences in the effectiveness of commonly used moisturisers for scar management.
The research aimed to evaluate how various moisturisers impact skin hydration and transepidermal water loss (TEWL) in individuals with active, linear, widespread or keloid scars.
Findings from the study have been published in the journal Burns.
The performance of eight moisturising products were evaluated using a tape-stripping method on normal skin to simulate the elevated TEWL conditions observed in active scars.
Thirty participants were recruited, with TEWL and hydration measurements recorded at baseline and hourly for four hours. Untreated tape-stripped areas served as controls for each participant.
The research demonstrated a significant difference between products commonly recommended for scar management in burn patients, said the authors.
“The ability of the products to increase hydration was highly variable, with some products nearly restoring hydration to normal skin levels, while others reduced hydration,” they wrote.
“In contrast, the ability of these products to normalise the elevated rates of transepidermal water loss (TEWL) was more challenging to achieve, making it difficult to distinguish between products in this regard.
“This suggests that moisturisers may be more effective when considered for their ability to hydrate scars rather than to normalise TEWL, which remains suboptimal.”
Lead researcher, PhD candidate and occupational therapist Tanja Klotz, said the study aimed to help clinicians make informed recommendations for scar treatment.
“We tell recovering patients about the importance of massage, moisturising and using pressure garments – there are evidence-based guidelines around best practice for massage and compression, but moisturiser is something that remains up to each clinician,” she said.
“We found that there was significant variability in the effectiveness of common moisturisers clinicians recommend for scar management.
“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.
“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.”
Eucerin Advanced Repair Cream, a US product that can be purchased online ranked the best, while Redwin sorbolene cream was third best.
“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 as the primary active ingredients after water,” says Miss Klotz.
“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.
“These findings highlight that higher cost does not necessarily correlate with superior outcomes.”
The authors noted their study included only a small subset of basic moisturiser products, and further research was needed to evaluate the many other cost-effective and widely available products for scar treatment.
“In addition to investigating different brands with various ingredients, it would be useful to study different formats of the same brand,” they said.
“Novel formulations should also be explored, but these should be cost-effective, compatible with pressure garments, hypoallergenic, and comfortable for the user.”
