title: Effects of petrolatum on stratum corneum structure and function. Profile of wound healing process induced by allantoin. Possibilities of scar treatment after thoracic surgery. A comparative study evaluating the tolerability and efficacy of two topical therapies for the treatment of keloids and hypertrophic scars. Onion Extract Gel Versus Petrolatum Emollient on New Surgical Scars: a Prospective Double‐Blinded Study The Effects of Topical Agent (Kelo-Cote or Contractubex) Massage on the Thickness of Post-Burn Scar Tissue Formed in Rats Mechanical evaluation of the resistance and elastance of post-burn scars after topical treatment with tretinoin Safety and efficacy of local administration of contractubex to hypertrophic scars in comparison to corticosteroid treatment. Results of a multicenter, comparative epidemiological cohort study in Germany. Prevention of Postsurgical Scars: Comparsion of Efficacy and Convenience between Silicone Gel Sheet and Topical Silicone Gel Pilot study evaluating topical onion extract as treatment for postsurgical scars. Phase 2 Cross-Over Multicenter Trial on the Efficacy and Safety of Topical Cyanoacrylates Compared with Topical Silicone Gel in the Prevention of Pathologic Scars The Efficacy of Topical Silicone Gel Elastomers in the Treatment of Hypertrophic Scars, Keloid Scars, and Post–Laser Exfoliation Erythema Role of silicone derivative plus onion extract gel in presternal hypertrophic scar protection: a prospective randomized, double blinded, controlled trial. Use of Onion Extract, Heparin, Allantoin Gel in Prevention of Scarring in Chinese Patients Having Laser Removal of Tattoos: A Prospective Randomized Controlled Trial Efficacy of Contractubex gel in the treatment of fresh scars after thoracic surgery in children and adolescents. Comparison of efficacy of silicone gel, silicone gel sheeting, and topical onion extract including heparin and allantoin for the treatment of postburn hypertrophic scars. The effects of onion extract on hypertrophic and keloid scars. Double‐Blind, Randomized, Placebo‐Controlled, Prospective Study Evaluating the Tolerability and Effectiveness of Imiquimod Applied to Postsurgical Excisions on Scar Cosmesis Hydration and occlusion treatment for hypertrophic scars and keloids. Successful Treatment of Earlobe Keloids with Imiquimod after Tangential Shave Excision
abstract: BACKGROUND Ointments ( e.g. , petrolatum ) are thought to be occlusive , thereby blocking transcutaneous water loss and trapping water under the skin 's surface . If this premise is correct , then petrolatum should delay barrier recovery after barrier perturbation , as shown previously in occluded murine skin . OBJECTIVE We reexamined the assumption that Vaseline Petroleum Jelly ( VPJ ) is occlusive , ascertaining both its site and mechanism of action . METHODS Barrier recovery was measured in VPJ-treated versus untreated sites after acetone-induced barrier disruption in human volunteers . Moreover , VPJ was localized within the stratum corneum ( SC ) with tracers and ruthenium tetroxide staining , which allowed visualization of the depth of VPJ penetration and its relation to intercellular membrane structures . RESULTS VPJ accelerated , rather than impeded , barrier recovery . Moreover , VPJ was present within the interstices at all levels of the SC , where it replaced intercellular bilayers . CONCLUSION VPJ neither forms nor acts like an epicutaneous impermeable membrane ; instead , it permeates throughout the SC interstices , allowing normal barrier recovery despite its occlusive properties PURPOSE To evaluate and characterize the wound healing process profile induced by allantoin incorporated in soft lotion oil/water emulsion using the planimetric and histological methods . METHODS Female Wistar rats ( n=60 ) were r and omly assigned to 3 experimental groups : ( C ) control group-without treatment ; ( E ) group treated with soft lotion O/W emulsion excipients ; ( EA ) group treated with soft lotion O/W emulsion containing allantoin 5 % . The emulsions either containing or not allantoin were topically administered for 14 days and the wound area was evaluated by planimetry and by qualitative and quantitative histological analysis of open wound model . RESULTS The data which were obtained and analyzed innovate by demonstrating , qualitatively and quantitatively , by histological analysis , the profile of healing process induced by allantoin . The results suggest that the wound healing mechanism induced by allantoin occurs via the regulation of inflammatory response and stimulus to fibroblastic proliferation and extracellular matrix synthesis . CONCLUSION This work show , for the first time , the histological wound healing profile induced by allantoin in rats and demonstrated that it is able to ameliorate and fasten the reestablishment of the normal skin During a ten year observation period it was found that scar formation after thoracic surgery is influenced by various factors : metabolism , operative technique and factors of a general nature . On the basis of these findings , a study was carried out to investigate the effect of the scar-specific Contractubex gel ( Merz+Co . , D-Frankfurt/Main ) , containing 10 % onion extract , 50 U sodium heparin per g of gel and 1 % allantoin , in the treatment of children who underwent thoracic surgery and to evaluate its effect on scar development . Before and during the six-month treatment period , both macromorphology and scar colour were assessed ; furthermore , a global evaluation of the therapeutic result was made . Additionally , the scars were characterized after a six-month treatment-free follow-up period . The results of 38 Contractubex-treated and 27 untreated patients were compared . In the treated scars , the global evaluation of the therapeutic result was better than in the untreated scars . In the Contractubex group , the rating was " good " and " very good " in 84 % of cases , as compared to 59 % of the untreated cases . In the treated group , the increase in scar size was markedly lower than in the untreated patients . The treated scars showed a tendency towards quicker paling than the untreated scars . In the treated group , the conversion of primary physiological scars to unphysiological scars ( hypertrophic or keloidal scars ) was less frequent than in the untreated group . The tolerability of the product was very good in 37 of the 38 treated patients , and good in one patient . All scar-specific effects of Contractubex continued to persist after the end of treatment BACKGROUND Onion extract gel ( OE ) and 0.5 % hydrocortisone , silicone and vitamin E lotion ( HSE ) are two over-the-counter preparations used to enhance the cosmesis of keloids and hypertrophic scars . OBJECTIVE To determine the tolerability and efficacy of OE versus HSE versus placebo in subjects with keloids and hypertrophic scars . METHODS Thirty subjects ( > or = 18 years ) with keloids or hypertrophic scars were r and omly assigned to one of three study preparations for 16 weeks . Scar volume was measured at baseline and weeks 4 , 8 , 12 and 16 . Subjects and blinded investigators assessed scar parameters ( in duration , erythema , pigmentation alteration , pain , itching , tenderness and cosmetic appearance ) and patient satisfaction at each visit using a visual analog scale ( VAS ) . Data analysis included : mean percentage change ( MPC ) for subjects completing the study ( n = 15 ) ; the mixed model test to determine differences between the groups over time ; and the Kruskal-Wallis test for the analysis of differences in subjects ' satisfaction within the three groups over 16 weeks for subjects who completed at least one follow-up visit ( n = 21 ) . RESULTS All three preparations were well tolerated with the exception of a mild acneiform-like eruption in one OE patient . Significant improvements were obtained with OE in volume , length , width and in duration and with  HSE in volume , length , in duration , erythema and pigmentation alteration . There was a trend showing that a higher percentage of subjects were satisfied with OE than with HSE or placebo . The Mix Model Analysis ( MMA ) showed significant improvements with OE over placebo in investigator cosmetic assessment , lesion in duration , pigmentation and tenderness and with  HSE  over placebo in investigator cosmetic assessment , lesion in duration , pigmentation and erythema . Improvements in erythema and pigmentation were significantly greater in HSE than in OE . CONCLUSION Both OE and HSE were more effective than placebo in the management of hypertrophic scars and keloids BACKGROUND Cutaneous scars result ing from surgical procedures can be erythematous , hypertrophic , pruritic , painful , or cosmetically unacceptable . An onion extract-based topical gel ( Mederma , Merz Pharmaceuticals ) has been marketed as a product to improve scar appearance and texture . However , few data are available to substantiate these cl aims . OBJECTIVE To compare the efficacy between the onion extract gel and a petrolatum-based emollient ( Aquaphor , Beiersdorf , Inc. ) in improving the appearance and symptoms of new surgical scars .  METHODS Twenty-four patients with new surgical wounds at least 4 cm in length were enrolled in the study . Using a r and omized , double-blinded , split-scar study design , each scar was divided into two equal portions , and each half was assigned treatment with either onion extract gel or petrolatum ointment at the time of suture removal . Each product was applied three times daily for 8 weeks , and patients were evaluated at 2 , 8 , and 12 weeks following initiation of treatment . A follow-up phone interview was conducted at least 11 months postoperatively . RESULTS Scar halves were evaluated by blinded investigators for overall cosmetic appearance , erythema , and hypertrophy . Patients also independently rated side-specific erythema , pruritus , burning , and pain . Using the paired t-test and the Wilcoxon sign-rank test , we found no statistically significant difference ( p < .1 ) between the two treatment groups in any of the outcome variables studied . CONCLUSION Petrolatum-based topical agents constitute st and ard therapy in the management of postoperative wounds . In this side-by-side , r and omized , double-blinded , split-scar study , the onion extract gel did not improve scar cosmesis or symptomatology when compared with a petrolatum-based ointment Background We conducted an experimental study to compare the effect of massage using topical agents ( Kelo-cote or Contractubex ) on scar formation by massaging the healed burn wound on the dorsal area of Sprague-Dawley ( SD ) rats . Methods Four areas of second degree contact burn were made on the dorsal area of each of 15 SD rats , using a soldering iron 15 mm in diameter . After gross epithelialization in the defect , 15 SD rats were r and omly divided into four groups : the Kelo-cote group , Contractubex group , Vaseline group , and control group . Rats in three of the groups ( all but the Control group ) were massaged twice per day for 5 minutes each day , while those in the Control group were left unattended . For histologic analysis , we performed a biopsy and evaluated the thickness of scar tissue . Results In the Kelo-cote and Contractubex groups , scar tissue thicknesses showed a significant decrease , compared with the Vaseline and control groups . However , no significant differences were observed between the Kelo-cote and Contractubex groups . In the Vaseline group , scar tissue thicknesses showed a significant decrease , compared with the control groups . Conclusions The findings of this study suggest that massage using a topical agent is helpful in the prevention of scar formation and that massage only with lubricant ( no use of a topical agent ) also has a considerable effect , although not as much as the use of a topical agent . Thus , we recommend massage with a topical agent on the post-burn scar as an effective method for decreasing the scar thickness OBJECTIVE : After burn injuries , scarred skin lacks elasticity , especially in hypertrophic scars . Topical treatment with tretinoin can improve the appearance and quality of the skin ( i.e. , texture , distensibility , color , and hydration ) . The objective of this prospect i ve study was to examine the effects of treatment with 0.05 % tretinoin for one year on the biomechanical behavior and histological changes undergone by facial skin with post-burn scarring . Setting : Tertiary , Institutional . METHOD : Fifteen female patients who had suffered partial thickness burns with more than two years of evolution were selected .  Skin biopsies were obtained initially and after one year of treatment . The resistance and elastance of these skin biopsies were measured using a mechanical oscillation analysis system . The density of collagen fibers , elastic fibers , and versican were determined using immunohistochemical analysis . RESULTS : Tretinoin treatment significantly lowered skin resistance and elastance , which is a result that indicates higher distensibility of the skin . However , tretinoin treatment did not significantly affect the density of collagen fibers , elastic fibers , or versican . CONCLUSION : Topical tretinoin treatment alters the mechanical behavior of post-burn scarred skin by improving its distensibility and thus leads to improved quality of life for patients OBJECTIVES To investigate the safety and efficacy of Contractubex administration to  hypertrophic scars  in routine out-patient practice and to compare it to corticosteroid treatment . PATIENTS AND METHODS This was a multicenter , retrospective cohort study , based on 38 r and omly selected practice s representatively distributed in Germany , including dermatologists and general practitioners . Data from 859 patients fulfilling the inclusion criteria were assessed and analyzed . Of these , 771 patients were eligible for the per protocol treatment with Contractubex  ( n=555 ) and corticosteroid ( n=216 ) . The safety and efficacy of local administration of Contractubex to hypertrophic scars was compared to corticosteroid treatment . RESULTS At the end of defined treatment periods ( minimum 28 days for local therapy with 1 intralesional corticosteroid application ) , normalization of the pre-treatment pathological parameters ( erythema , pruritus , consistency ) of hypertrophic scars was more frequent ( 42.5 % ) after Contractubex per protocol treatment as compared to corticosteroid per protocol treatment ( 22.2 % ) . After adjusting imbalances of baseline characterisics between the treatment groups by the propensity score , the odds ratio was 2.274 , demonstrating a significant superiority ( p<0.001 ) of Contractubex treatment as compared to corticosteroid treatment . The time to normalization of erythema , pruritus and consistency was significantly ( p=0.034 ) shorter with Contractubex treatment ( median 344 days ) than with corticosteroids ( median 507 days ) . No unexpected or severe adverse events occurred in the Contractubex-treated patients . Apart from moderate pruritus ( 10 % Contractubex vs. 1 % corticosteroids ) , adverse events were significantly ( p<0.001 ) more frequent in  corticosteroid-treated patients ( teleangiectasias 15 % vs. 7 % Contractubex ; cutaneous atrophy of scars 10 % vs. 2 % Contractubex ; cutaneous atrophy of scar surrounding skin tissue 11 % vs. 1 % Contractubex ) . CONCLUSION For the primary aim of this study ( assessment of normalization of erythema , pruritus , and consistency of hypertrophic scars ) and for time to normalization , local administration of Contractubex was significantly more effective than corticosteroid treatment . Concerning safety , Contractubex treatment was associated with significantly less adverse events ( e.g. teleangiectasias , cutaneous atrophy of scars and surrounding skin tissue ) than topical corticosteroid application To date , few studies have compared the effectiveness of topical silicone gels versus that of silicone gel sheets in preventing scars . In this prospect i ve study , we compared the efficacy and the convenience of use of the 2 products . We enrolled 30 patients who had undergone a surgical procedure 2 weeks to 3 months before joining the study . These participants were r and omly assigned to 2 treatment arms : one for treatment with a silicone gel sheet , and the other for treatment with a topical silicone gel .  Vancouver Scar Scale ( VSS ) scores were obtained for all patients ; in addition , participants completed scoring patient question naires 1 and 3 months after treatment onset . Our results reveal not only that no significant difference in efficacy exists between the 2 products but also that topical silicone gels are more convenient to use . While previous studies have advocated for silicone gel sheets as first-line therapies in postoperative scar management , we maintain that similar effects can be expected with topical silicone gel . The authors recommend that , when clinicians have a choice of silicone-based products for scar prevention , they should focus on each patient 's scar location , lifestyle , and willingness to undergo scar prevention treatment . Graphical BACKGROUND Post surgical scars can be erythematous , raised , pruritic and painful . Numerous modalities are available to improve the appearance and symptomatology of these scars . A topical onion gel extract is the newest in the armamentarium of scar treatments . The active ingredient in this gel is allium cepa . Published studies evaluating the usefulness of this gel in the treatment of scars are not available . OBJECTIVE To evaluate the effectiveness of topical onion gel extract in improving the appearance and symptomatology of postsurgical scars and to compare the results of its use to those of a topical emollient ointment . METHODS Seventeen patients with surgical scars result ing from Mohs surgery  were assigned to 1 of 2 groups on the day of suture removal . Each group applied a design ated topical product 3 times a day for 1 month . Photographic documentation and question naires using a visual analog scale were completed for each scar enrolled in the study . RESULTS Using the Fischer 's exact test , no statistically significant difference between pre- and posttreatment evaluations of scar erythema and pruritus in patients using topical onion extract gel was found . A statistically significant reduction in scar erythema was found in patients using a petrolatum based ointment . CONCLUSIONS Scar hydration is an important factor in wound healing and can be achieved with topical petrolatum-based ointment . Topical onion gel extract was ineffective in improving scar erythema and pruritus in our patients Background Many clinical studies on scar therapy are reported in the literature , but only silicone gel sheeting and corticosteroid injections are supported by accurate prospect i ve controlled studies . This prospect i ve multicenter cross-over phase 2 study tested the effectiveness of a topical cyanoacrylate compared with silicone gel in improving postsurgical scars Methods Patients presenting with symmetric breast scars after augmentation or reduction mammaplasty were enrolled in the study . From the same day as stitch removal , the cyanoacrylate was applied on one side every 3 to 5 days and the silicone gel on the other side twice a day for 3 months . Assessment s of patients and external observers using a visual analog scale were recorded at scheduled visits during 1 year , and scars were photographed . Objective evaluations included measurements of scar width , length , and elevation . The statistical significance of objective parameter modifications was analyzed using the Wilcoxon test Results Positive effects of both tested products were observed during the scar maturation process , and final scars of good quality were achieved without any major adverse effect . The topical cyanoacrylate proved to be more efficacious in preventing scar widening , and this result was statistically significant Conclusions The tested topical cyanoacrylate had a positive effect on the scar maturation process at least comparable with that of topical silicone gel Background Dermatix is a Food and Drug Administration ( FDA ) -registered substantial equivalent to silicone gel sheeting for the prevention and management of hypertrophic scars and keloids . Methods A 90-day prospect i ve study evaluated the efficacy of Dermatix , silicone gel sheeting , and a combination of these treatments in improving scars for 30 patients . Each patient had a bilateral scar that served as an untreated control . The outcome measures included profilometry analysis of scar topography before and after punch biopsies of the control and treated scars , symptoms associated with the scars , and patient evaluations of the ease of treatment . Results The results showed better resolution and improvement of scars with Dermatix treatment or the combined use of Dermatix and silicone gel sheeting than with silicone gel sheeting alone .  Wound erythema was reduced , and collagen architectural reorientation was demonstrated histologically . Patients rated Dermatix as easier to use than silicone gel sheeting . Both Dermatix and silicone gel sheeting reduced symptoms of itching , irritation , and skin maceration . Conclusion The results of this study indicate that Dermatix is a useful treatment for the management of abnormal scarring Use of silicone derivative and onion extract had been reported in the prevention of hypertrophic scarring . Our experience showed the preventive use of silicone derivative plus onion extract gel on hypertrophic scars after median sternotomy . In a r and omized , double blinded , placebo-controlled study , 60 patients after median sternotomy incisions were separated into two groups . All patients were treated either with silicone derivative plus onion extract gel ( Cybele ( ® ) scagel ) or placebo gel twice daily for a total treatment period of 12 weeks . During each visit , pain and itching scores were grade d by the patients and scar characteristics were observed by surgeons using the Vancouver scar scale . Pain and itch score values from patients ' who applied silicone derivative plus onion extract gel was less than another group ( P < 0·05 ) . Pigmentation was significantly different between two groups ( P < 0·05 ) and the reduction of scores on vascularity , pliability , height in treated group was not superior to the untreated group . No adverse events were reported by any of the patients . A silicone derivative plus onion extract gel is safe and effective for the preventing the hypertrophic scarring after median sternotomy BACKGROUND With rapid advancement in cutaneous laser therapy , Q-switched lasers have become the st and ard treatment for tattoo removal . The longer wavelength Q-switched Nd : YAG laser is used when removing tattoos in darker skin patients to avoid scarring and permanent pigment changes . Nevertheless , the local experience revealed that nearly 25 % of the Chinese patients developed scarring . Meanwhile , multiple clinical studies have shown that Contractubex gel ( Merz Pharma , Frankfurt , Germany ) was effective in the treatment and prevention of hypertrophic scars and keloids . OBJECTIVE To evaluate the efficacy of Contractubex gel in the prevention of scarring after laser removal of tattoos in Chinese patients . METHODS A total of 120 Chinese patients with 144 professional blue-black tattoos were recruited into the study . They were r and omly assigned into the Contractubex group or the control group . All patients were treated with a QS 1,064-nm Nd : YAG laser using a 3-mm spot size , a 10-Hz repeat rate , a pulse duration of 6 nanoseconds , and fluences that ranged from 3.6 to 4.8 J/cm2 ( mean fluence , 4.2 J/cm2 ) . The treated areas were assessed 3 months after the last treatments for clinical clearance and complications . RESULTS Fifty-two patients with 61 tattoos in the Contractubex group were able to achieve a mean clearing rate of 82.3±11.6 % . There were 7 tattoos in 7 patients that developed scarring , 4 patients had permanent hypopigmentation , and 3 patients had transient hyperpigmentation . In contrast , 55 patients with 68 tattoos in the control group had a mean clearing rate of 80.4±11.3 % . Among them , 16 tattoos in 14 patients developed scarring , 4 patients had permanent hypopigmentation , and 5 patients had transient hyperpigmentation . Although there was no significant difference in age , sex , fluence , treatment session , and clinical clearance between the two groups , the Contractubex group had a statistically significantly lower rate of scarring than the control group ( p<.05 ) . CONCLUSION Contractubex gel is effective in scar prevention in Chinese patients having laser removal of tattoos Scar development was investigated in 45 young patients who had undergone thoracic surgery . Patients were r and omly assigned either to a group which was treated topically with Contractubex gel ( Merz + Co. , D-Frankfurt/Main ) , containing 10 % onion extract , 50/U of sodium heparin per one g of gel and 1 % allantoin , or to a group receiving no treatment . The treatment began on average 26 days after the operation and was continued for one year . The scars of all treated and untreated patients were evaluated at monthly intervals . The appearance of the scar , including scar type and scar size as well as scar colour , was assessed by the physician . A reduction of the increase of scar width was seen in the Contractubex-treated group as compared with the untreated group . Further , physiological scars and skin-coloured scars were more frequent in the treated group than in the untreated group . Hypertrophic or keloidal scars were less frequent in the treated group . No differences in scar length and scar height were seen . At the end of the observation period , the clinical course of scar development was rated as " very good " or " good " in more than 90 % of the treated patients , " good " in less than 40 % and " moderate " or " bad " in more than 60 % of the untreated cases . The tolerability of the drug was " good " or " very good " in all cases . In conclusion , Contractubex gel is useful in scar treatment after thoracic surgery We compared the efficacy of silicone gel ( Scarfade ) , silicone gel sheet ( Epi-Derm ) , and topical onion extract including heparin and allantoin ( Contractubex ) for the treatment of hypertrophic scars . Forty-five postburn scars were included in the study . Patients with scars less than 6 months from injury were assigned at r and om to three groups each containing 15 scars , and their treatment was continued for 6 months . Scars were treated with Scarfade , Epiderm and Contractubex .  Scar assessment was performed at the beginning of the treatment , and at the end of the sixth month when the treatment was completed by using the Vancouver scar scale . The difference between before and after treatment scores for each three groups was statistically significant . The difference between Scarfade group and Epi-Derm group was not significant ; however , the differences of the other groups ( Scarfade-Contractubex , Epiderm-Contractubex ) were significant . Silicone products , either in gel or sheet , are superior to Contractubex in the treatment of the hypertrophic scar . The therapist should select the most appropriate agent according to the patient 's need and guidelines of these signs OBJECTIVE To evaluate the therapeutic activity of topical onion extract in gel form on  hypertrophic and keloid scars  , focusing on problems such as elevation , redness , hardness , itching and pain . METHOD This comparative prospect i ve study assigned 60 patients to three groups . Group I was treated with onion extract alone , group 2 with silicon gel sheet alone and 3 group with a combination of onion extract and silicon gel sheet . RESULTS In the group comparisons , a significant difference was observed at the end of six months in the colour parameter between group I and group 2 and in the height parameter between group I and group 3 ( ANOVA post-hoc Tukey 's test , p<0.01 and p<0.05 respectively ) . The onion extract was more effective in relation to scar colour , while the silicon gel sheet was superior in decreasing the height of scar ( paired sample t-test , p<0.001 ) . In addition , the most effective therapeutic results were obtained when the silicon gel sheet treatment was combined with onion extract in group 3 . CONCLUSION Onion extract improved hypertrophic and keloids scars via multiple mechanisms . However , it was statistically ineffective in improving scar height and itching . For this reason , onion extract therapy should be used in combination with an occlusive silicon dressing to achieve a satisfying decrease in scar height Background It has been reported that topical application of imiquimod 5 % cream induces interferon-α , an antifibrotic cytokine . Objective To determine the tolerability and effectiveness on the cosmetic outcome of the application of imiquimod to postsurgical excision sites . Material s and Methods A prospect i ve , double-blinded , r and omized , vehicle-controlled trial was conducted among 20 patients with two skin lesions clinical ly diagnosed as melanocytic nevi .  Imiquimod 5 % cream was applied to one of the sutured surgical wounds starting the night of the excision nightly for a period of 4 weeks . The second sutured excision site was treated with vehicle cream . Scar cosmesis , erythema , pigmentary alterations , in duration , tenderness , and pain were assessed using a visual analogue scale 2 , 4 , and 8 weeks after surgery . Results Eighteen subjects completed the study , with a total of 36 excision sites ; no wound site dehisced , and no signs of infection were noted . Surgical wounds treated with imiquimod had more erythema , pigmentary alterations , and lower cosmesis rated by the investigator compared with wounds treated with placebo , both becoming nonsignificant in further evaluations . For pigmentary alterations , in duration , and cosmesis rated by the patients , no statistically significant difference between treatment groups was observed at week 8 . Conclusion Treatment of surgical excision-site wounds with imiquimod was well tolerated and without serious adverse events . Evaluations for cosmesis of placebo-treated surgical sites were better than imiquimod-treated sites at week 8 , becoming nonsignificant later In 31 patients with hypertrophic scars or keloids , a side by side test was carried out to check the efficacy of an occlusive dressing technique using cream which did not contain silicone oil , versus a simple application of vaseline , used as a control . In all cases , the cream treated areas of scar and keloid demonstrated a remarkable improvement over that of the vaseline treated area . These findings strongly suggest that the mechanisms of hydration and occlusion are the main basis of the therapeutic action of this method in treating hypertrophic scars and keloids BACKGROUND The treatment of earlobe keloids has historically been suboptimal ; characterized by discomfort , poor response , and high rates of recurrence . Keloids are characterized by increased fibroblast activity in the setting of an altered cytokine profile . OBJECTIVE To investigate whether topical imiquimod 5 % cream applied postoperatively after tangential excision can prevent recurrence of earlobe keloids . METHODS AND MATERIAL S Four patients with a total of eight large pedunculated earlobe keloids ( five of which were recurrent lesions ) were treated with debulking by tangential shave excision followed by daily application of imiquimod 5 % cream for 6 weeks . RESULTS At 6 and 12 months post-treatment there was an excellent cosmetic result and no evidence of recurrence in any of the lesions . Patients with keloids that were itchy and painful  were completely asymptomatic at the conclusion of the study . CONCLUSION In this pilot study , imiquimod 5 % cream following tangential shave excision was efficacious for the treatment of earlobe keloids . Further study is warranted to confirm the utility of imiquimod 5 % cream in the treatment of earlobe keloids , as illustrated herein
target: Contractubex showed best results in the prevention of pathological scars .
background: BACKGROUND The treatment and prevention of  hypertrophic scars and keloids  represents a special challenge particularly in plastic surgery .
  Given their simple , non-invasive and painless application , topical preparations are an attractive therapeutic option .
  On the part of the patients , the efficacy in prevention of and therapy for hypertrophic scars and keloids of these topical preparations is regularly question ed .
  The clarification of this issue is subject of this review .