The cheaper, the better: The ‘game-changer’ scar treatment study

Scars are the body’s way of replacing lost or damaged skin, but the way they look and feel depends very much on how they are managed. While massage can improve circulation around the wound and promote healing, there has been little investigation into the myriad moisturisers suggested for improving newly formed skin and minimising the appearance of scars.

That is, until now. According to a recent University of Adelaide-backed study published in Burns Open, the type of moisturiser used on an active (healing) scar makes a difference – and it’s not the most expensive product that prevails. Occupational therapist and co-author of the study Tanja Klotz says she was prompted to conduct the study because information on the effectiveness of moisturisers was so scarce.

“The evidence was really poor on the effect of moisturisers on scars. We had nothing to guide us,” Klotz says.

Klotz and her co-authors tested eight different moisturisers – including generic products such as Sorbolene, QV Lotion and Bio-Oil – to see how well they hydrate and normalise TEWL (transepidermal water loss, which is the natural process of water evaporating from the skin’s deeper layers to the environment).

The study found that the priciest moisturisers weren’t necessarily ideal for scar management, with hospital-recommended products such as Strataderm Scar Therapy Gel, which costs $5 per millilitre, ranking second-worst overall.

“You smear [Strataderm] across a scar, and they say it dries to form a silicone gel sheet, which does really slow down that rate of water loss,” Klotz says. “[But Strataderm’s] ability to normalise TEWL was similar to putting on a very thin, light moisturiser.”

Why does this matter?

Alvin Chong, adjunct associate professor and dermatologist at The University of Melbourne and Skin Health Institute, calls the study a “game-changer”.

“Every surgical professional has their own favourite cream, so this study has really opened my eyes,” Chong says. “It shows you don’t have to have the expensive stuff.”

This is especially valuable given those with active scars must apply moisturiser two to three times a day, often for up to a year or more. So the more affordable it is, the better.

Conversations around scars are growing, with several celebrities publicly embracing theirs. Princess Eugenie married in 2018 in an open-back dress, showing her scoliosis scar, she said, to inspire others with the condition and pay respect to those who helped her through the experience. The princess had surgery to treat the curvature in her spine at the age of 12.

“I think you can change the way beauty is, and you can show people your scars, and I think it’s really special to stand up for that,” she told ITV’s This Morning at the time.

Singer Selena Gomez has also shared images of her kidney transplant scar, and television host Padma Lakshmi has been vocal about her scar, which she got after a car crash when she was 14.

“Some people with mastectomy scars have run marathons topless to show their scars,” Chong says. “They have a cause to promote – the body positivity movement. They’re saying it’s part of who they are, and so there’s a bit less stigma around scars.

“However, scars can still be very distressing for people … They’re disfiguring. If you get a scar, there’s no guarantee you’re going to like it, claim it and own it. Keloid scars especially can be very uncomfortable, itchy and sore.”

All the more reason to know how to properly manage an active scar, Chong notes. “We always say, a nice-looking scar is a good scar.”

Scar treatment: a step-by-step guide

Every scar is different, Klotz says. However, there are several broad categories that most scars fit within, including normotrophic, hypertrophic and keloid.

A multi-modal approach is usually best for active scar treatment, says Marcus Wagstaff, head of unit of the Adult Burns Service at the Royal Adelaide Hospital.

Before applying any product, the wound must heal.

“Once it’s healed, you can start moisturising. Normally, we recommend three times a day. For minor wounds, perhaps twice a day,” Wagstaff says. “Really massage the moisturiser into the scar, either in a circular motion or in longitude or crosswise motion, so you’re getting it from all angles.”

Associate professor and dermatologist from UNSW Deshan Sebaratnam says keeping a scar hydrated is vital because scarred skin has more TEWL than normal skin. “Wounds shouldn’t dry out as it’s thought this can stop the healing cells from migrating across the wound.”

When choosing a moisturiser, Sebaratnam suggests keeping it simple. “The cheap stuff is often better than the expensive stuff. You want something bland and greasy, ideally free of preservatives, fragrances and food products.”

Compression garments can also be helpful, Wagstaff adds, particularly for those with large burn scars. Another option is steroid injections, which can help reduce inflammation and “kick-start” scar maturation.

“Treat your scar like a baby of the same age,” Wagstaff says. “So if you’re going out into direct sunlight, cover up your scar. Don’t use abrasives on it. Treat it as if it were new baby skin … If you’re stimulating the scar and making it more inflamed, you can only expect it to last longer, so try not to antagonise it.”

What next?

Klotz hopes her study will encourage clinicians to think twice before suggesting certain moisturisers to scar patients and to be more aware of marketing behind popular brands.

“A certain product may feel nice, smell nice and facilitate massage … But it’s not the product that’s helping, it’s the massaging,” she says. “It’s similar to the beauty industry. People might walk into a chemist and think one is more expensive, so it’s going to work better. However, that’s not necessarily the case.

“Start showing us real data that’s applicable to what we need.”

All this said, Wagstaff says, it’s better to use any kind of moisturiser than none – as long as it’s applied properly (massaging deeply around the entire affected area) and frequently enough.

“The main concern is that people are applying a moisturiser and protecting their scar from sunlight,” he says. “The data shows [predominantly] oil-based moisturisers are stronger. However, further work needs to be done … We’re just scratching the surface, as it were.”

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