J0137 Cortisone Injections and Silicone Patches for

TITLE: Cortisone Injections and Silicone Patches for Minimizing Facial Scars: Clinical
Effectiveness and Guidelines for Use
DATE: 18 November 2008
RESEARCH QUESTIONS:
1.
What is the clinical effectiveness of cortisone injections and silicone patches for the
minimization of facial scars in adult patients after the removal of sutures?
2.
Is there evidence for the timeframe of healing that cortisone injections and silicone
patches provide the greatest improvement for facial scarring?
3.
Are repeat injections of cortisone required and, if so, at what frequency?
4.
What are the guidelines for the use of cortisone injections and silicone patches for facial
scar minimization in adult patients?
METHODS:
A limited literature search was conducted on key health technology assessment resources,
including PubMed, the Cochrane Library (Issue 4, 2008), University of York Centre for Reviews
and Dissemination (CRD) databases, ECRI, EuroScan, international health technology
agencies, and a focused Internet search. Results include articles published between 2003 and
November 2008, and are limited to English language publications only. No filters were applied to
limit the retrieval by study type. Internet links are provided, where available.
RESULTS:
The literature search did not identify any health technology assessments, systematic reviews,
meta-analyses, randomized controlled trials, controlled clinical trials, observational studies, or
guidelines specific to cortisone injections or silicone patches for the minimization of facial scars
after suture removal in adult patients. Articles that are not specific to facial scars are included in
the appendix, along with additional articles of potential interest.
Disclaimer: The Health Technology Inquiry Service (HTIS) is an information service for those involved in planning and providing
health care in Canada. HTIS responses are based on a limited literature search and are not comprehensive, systematic reviews.
The intent is to provide a list of sources of the best evidence on the topic that CADTH could identify using all reasonable efforts
within the time allowed. HTIS responses should be considered along with other types of information and health care considerations.
The information included in this response is not intended to replace professional medical advice, nor should it be construed as a
recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality
evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for
which little information can be found, but which may in future prove to be effective. While CADTH has taken care in the preparation
of the report to ensure that its contents are accurate, complete and up to date, CADTH does not make any guarantee to that effect.
CADTH is not liable for any loss or damages resulting from use of the information in the report.
Copyright: This report contains CADTH copyright material and may contain material in which a third party owns copyright. This
report may be used for the purposes of research or private study only. It may not be copied, posted on a web site,
redistributed by email or stored on an electronic system without the prior written permission of CADTH or applicable copyright
owner.
Links: This report may contain links to other information on available on the websites of third parties on the Internet. CADTH does
not have control over the content of such sites. Use of third party sites is governed by the owners’ own terms and conditions.
Health technology assessments
No literature identified
Systematic reviews and meta-analyses
No literature identified
Randomized controlled trials
No literature identified
Controlled clinical trials
No literature identified
Observational studies
No literature identified
Guidelines and recommendations
No literature identified
PREPARED BY:
Karen Cimon, Research Assistant
Carolyn Spry, MLIS, Information Specialist
Health Technology Inquiry Service
Email: [email protected]
Tel: 1-866-898-8439
Cortisone Injections and Silicone Patches for Minimizing Facial Scars
2
APPENDIX – FURTHER INFORMATION:
Systematic reviews and meta-analyses
1.
O'Brien L, Pandit A. Silicon gel sheeting for preventing and treating hypertrophic and
keloid scars. Cochrane Database Syst Rev 2006;(1):CD003826. PubMed: PM16437463
Randomized controlled trials
2.
Momeni M, Hafezi F, Rahbar H, Karimi H. Effects of silicone gel on burn scars. Burns
2008. PubMed: PM18672332
3.
Li-Tsang CW, Lau JC, Choi J, Chan CC, Jianan L. A prospective randomized clinical trial
to investigate the effect of silicone gel sheeting (Cica-Care) on post-traumatic
hypertrophic scar among the Chinese population. Burns 2006;32(6):678-83. PubMed:
PM16837136
Observational studies
4.
Lacarrubba F, Patania L, Perrotta R, Stracuzzi G, Nasca MR, Micali G. An open-label
pilot study to evaluate the efficacy and tolerability of a silicone gel in the treatment of
hypertrophic scars using clinical and ultrasound assessments. J Dermatolog Treat
2008;19(1):50-3. PubMed: PM18273725
5.
Chernoff WG, Cramer H, Su-Huang S. The efficacy of topical silicone gel elastomers in
the treatment of hypertrophic scars, keloid scars, and post-laser exfoliation erythema.
Aesthetic Plast Surg 2007;31(5):495-500. PubMed: PM17700980
6.
Ayhan M, Gorgu M, Silistreli KO, Aytug Z, Erdogan B. Silastic sheet integrated
polymethylmetacrylate splint in addition to surgery for commissure contractures
complicated with hypertrophic scar. Acta Chir Plast 2004;46(4):132-5. PubMed:
PM15715146
7.
Eishi K, Bae SJ, Ogawa F, Hamasaki Y, Shimizu K, Katayama I. Silicone gel sheets
relieve pain and pruritus with clinical improvement of keloid: possible target of mast cells.
J Dermatolog Treat 2003;14(4):248-52. PubMed: PM14660274
Review articles
8.
Mustoe TA. Evolution of silicone therapy and mechanism of action in scar management.
Aesthetic Plast Surg 2008;32(1):82-92. PubMed: PM17968615
9.
Reish RG, Eriksson E. Scars: a review of emerging and currently available therapies.
Plast Reconstr Surg 2008;122(4):1068-78. PubMed: PM18827639
10.
Atiyeh BS. Nonsurgical management of hypertrophic scars: evidence-based therapies,
standard practices, and emerging methods. Aesthetic Plast Surg 2007;31(5):468-92.
PubMed: PM17576505
Cortisone Injections and Silicone Patches for Minimizing Facial Scars
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11.
Berman B, Perez OA, Konda S, Kohut BE, Viera MH, Delgado S, et al. A review of the
biologic effects, clinical efficacy, and safety of silicone elastomer sheeting for
hypertrophic and keloid scar treatment and management. Dermatol Surg
2007;33(11):1291-302. PubMed: PM17958580
12.
Al-Attar A, Mess S, Thomassen JM, Kauffman CL, Davison SP. Keloid pathogenesis and
treatment. Plast Reconstr Surg 2006;117(1):286-300. PubMed: PM16404281
13.
Zurada JM, Kriegel D, Davis IC. Topical treatments for hypertrophic scars. J Am Acad
Dermatol 2006;55(6):1024-31. PubMed: PM17097399
14.
Hackett J. There is evidence (level 1b) that non-silicone polyurethane gel dressings are
significantly more effective in reducing the cosmetic severity of mature hypertrophic
scars than silicone gel dressings. In: Occupational therapy critically appraised topics
[website]. Lidcombe (AU): Annie McCluskey; 2005. Available:
http://www.otcats.com/topics/index.html (accessed 2008 Nov 14).
15.
Alster TS, Tanzi EL. Hypertrophic scars and keloids: etiology and management. Am J
Clin Dermatol 2003;4(4):235-43. PubMed: PM12680802
Additional references
16.
Briggs SL, Taylor A, Lansdown AB. Clinical perspective on silicone dressings and wound
management. J Wound Care 2008;17(8):364-5. PubMed: PM18754199
17.
Reish RG, Eriksson E. Scar treatments: preclinical and clinical studies. J Am Coll Surg
2008;206(4):719-30. PubMed: PM18387479
18.
Rivera AE. Acne scarring: a review and current treatment modalities. J Am Acad
Dermatol 2008;59(4):659-76. PubMed: PM18662839
19.
Hypertrophic scars and keloids, treatments. In: Clinical Policy Bulletins [database
online]. Number 0389: Harford (CT): Aetna; 2008. Available:
http://www.aetna.com/cpb/medical/data/300_399/0389.html (accessed 2008 Nov 14).
20.
Colom Maján JI. Evaluation of a self-adherent soft silicone dressing for the treatment of
hypertrophic postoperative scars: Negative pressure wound therapy to treat hematomas
and surgical incisions following high-energy trauma. J Wound Care 2006;15(5):193-6.
Cochrane ID: CN-00605494
21.
Fette A. Influence of silicone on abnormal scarring. Plast Surg Nurs 2006;26(2):87-92.
PubMed: PM16783182
22.
Edwards J. Scar management. Nurs Stand 2003;17(52):39-42. PubMed: PM14533225
23.
Gilman TH. Silicone sheet for treatment and prevention of hypertrophic scar: a new
proposal for the mechanism of efficacy. Wound Repair Regen 2003;11(3):235-6.
PubMed: PM12753606
Cortisone Injections and Silicone Patches for Minimizing Facial Scars
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