Clinicals

1. Zurada JM, Kriegel D, Davis IC. Topical treatments for hypertrophic scars. J Am Acad Dermatol 2006;55:1024-1031. (excellent review article defining SGS as the first line therapy and underscoring the lack of efficacy of  creams or ointments containing Vitamin A, Vitamin E, onion extract (Mederma), and other commonly used therapies).
   
   
2. Harrison C et al. Investigation of keratinocyte regulation of collagen 1 synthesis by dermal fibroblasts in a simple in vitro model. Br J Dermatol 2006 Mar; 154(3): 401-410. (In vitro study confirming the ability of cultured keratinocytes to downregulate fibroblast collagen production, which is part of the current model explaining the efficacy of  SGS).
   
   
3. So K et al. Effects of enhanced patient education on compliance with silicone gel sheetingand burn scar outcome: a randomized prospective study. J Burn Care Rehabil 2003 Nov-Dec; 24(6) 411-417. (Study demonstrating the benefit of SGS but also the importance of instruction to improve compliance and  outcome).
   
   
4. Gold MH et al. Prevention of hypertrophic scars and keloids by the prophylactic use of topical silicone gel sheets following a surgical procedure in an office setting. Dermatol Surg 2001 Jul; 27(7): 641-644. (Randomized prospective in office study demonstrating a reduction of HS and keloids in high risk individuals from 71% to 39% using SGS therefore demonstrating that it could indeed PREVENT abnormal scars; also noted a benefit after re-excision of abnormal scars. ).
   
   
5. Kuhn M et al. Silicone sheeting decreases fibroblast activity and downregulates TGF-B2 in hypertrophic scar model. I Journal of Surgical Investigation 2001; 2(6): 467-474. ( TGF-B2 is a cytokine implicated in excess scar production. This in vitro analysis demonstrated a significant reduction in fibroblast TGF-B2 production when exposed to silicone sheeting over controls (no exposure versus Saran wrap). 
   
   
6.  Borgognoni L et al. Hypertrophic scars and keloids: imunophenotypic features and silicone sheets to prevent recurrences. Annals of Burns and Fire Disasters 2000 Sep; 13(3): 1-9. (Study demonstrating a reduction in recurrent keloids treated with excision and SGS (10%) compared to excision alone (60%) (p<0.05).
   
   
7. Garner WL. Epidermal Regulation of Fibroblast Activity. Plastic and Reconstructive Surgery 1998 July; 102(1):135-139. (“Dermal fibroblast collagen synthesis appears to be regulated by a soluble keratinocyte product.”; further evidence revealing the dynamic interaction between the epidermis and dermis , part of the proposed mechanism of SGS.)
   
   
8. Kruz-Korchin NI. Effectiveness of Silicone Sheets in the Prevention of Hypertrophic Breast Scars. Ann Plast Surg 1996; 37:345-348. (Reduction of hypertrophic scarring noted in reduction mammoplasties from 60 to 25% (p<0.05) in patients using SGS versus no therapy on the opposite breast. Again, another study demonstrating silicone’s efficacy in PREVENTING abnormal scariing in high risk patients).
   
   
9. Suetake T et al. Functional Analyses of the Stratum Corneum in Scars.Arch Dermatol  1996; 132: 1453-1458. (Great study documenting the abnormal TEWL in abnormal scars, which currently is hypothesized to increase scar formation)
   
   
10. Chi-Cheng et al. Hydration, Not Silicone, Modulates the Effects of Keratinocytes on Fibroblasts. Journal of Surgical Research 1995; 59(6): 705-711.  (Excellent article/ in vitro study demonstrating the effect of hydration on keratinocyte cytokine production and subsequent fibroblast modulation. The authors postulate that silicone’s effect on fibroblasts is not based on the material itself but its ability to maintain the skin in a optimally hydrated state.)
    
    
11. Nickoloff, BJ and Naidu Y. Perturbation of epidermal barrier function correlates with initiation of cytokine cascade in human skin. J Am Acad Dermatol 1994 Apr; 30(4): 535-546. (Another excellent article demonstrating significant increase in inflammatory cytokine mRNA and keratinocyte activation associated with tape stripping (human subjects) by skin punch biopsy. This suggests why tape SHOULD NOT BE USED REPEATEDLY (most other silicone products sell tape to hold their product in place) as keratinocyte activation can lead to fibroblast activation and more scarring!)  
    
    
12. Gold MH. Topical Silicone Gel Sheeting in the Treatment of Hypertrophic Scars and Keloids 1993. J Dermatol Surg Oncol; 19: 912-916. (An earlier Gold article from the Gold Skin Care Center in Nashville, TN demonstrating moderate improvement in abnormal scars with silicone gel sheeting).
    
    
13. Ahn ST, Monafo WM and Mustoe TA. Topical Silicone Gel for the Prevention and Treatment of Hypertrophic Scar. Arch Surg 1991 Apr; 126:499-504. (A prospective trial demonstrating reduction of scar volume after surgical incisions in gel treated subjects versus untreated controls (P=.03)).
    
    
14. Sproat JE et al. Hypertrophic Sternal Scars: Silicone Gel Sheet versus Kenalog Injection Treatment. Plastic and Reconstructive Surgery 1992 Dec; 90(6): 988-992. (Split-scar study on established hypertrophic sternotomy scars comparing intralesionl steroid injection to silicone gel sheeting. Conclusions were that 11/14 subjects preferred silicone to steroids (p<0.05) and that silicone gel provide earlier symptom relief and a more aesthetic result). 
    
    
15.  Sawada Y. and Sone K. Treament of scars and keloids with a cream containing silicone oil. Br J Plast Surg 1990 Nov; 43(6): 683-688. (Study demonstrating reduced efficacy of silicone cream alone unless used with and occlusive dressing. The authors suggest that occlusion and hydration is the mechanism of action).
    
    
16. Macnee J. The Use of Silicone Gel in the Contro of Hypertrophic Scarring. Physiotherapy 1990; 76(4): 194-197. (This is an impressive article demonstrating the radical improvements in range of motion in burns and wounds associated with hypertrophic scars. A great article for ortho physicians and physical therapists for post-joint surgery where excess scarring leads to significant range of motion issues and loss of function.)
    
    
17.  Ahn ST, Monafo WW, and Mustoe TA. Topical silicone gel: A new treatment for hypertrophic scars. Surgery 1989; 106:781-787. (An earlier article from this collection of authors, notable perhaps as being first by Mustoe who had continued to publish about silicone products over two decades. )
    
    
18. Mercer NSG. Silicone gel in the treatment of keloid scars. Br J Plast Surg 1989; 42:83-87. (Early study demonstrating improvements in texture, color, and height in 18/22 keloid scars treated with silicone gel sheeting).
    
    
19.  Quinn KJ et al. Non-pressure treatment of hypertrophic scars. Burns Incl Therm Inj 1985 Dec; 12(2):102-108. (One of the most referenced articles in silicone scar literature revealing that silicones effects are not due to pressure or temperature but likely hydration).
    
    
20. Perkins K, Davey RB, and Wallis KA. Silicone gel: a new treatment for burn scars and contractures. Burns 1983; 9(3):201-204. (The original article on the use of silicone on burn patients and their impressive findings. The article that launched a thousand articles! From The Burns Unit, Adelaide Children’s Hospital, South Australia.) 
    
    
21.  Mustoe TA, Cooter RD, Gold MH et al. International clinical recommendations on scar  management. Plast Reconstr Surg 2002 Aug; 110(2); 560-571 (This international panel concluded that silicone gel sheeting was the “gold standard” in scar management.

Dr. Jon-Michael Bruce,
MD, FACS