Contractubex, a scar gel containing extractum cepae, heparin, and allantoin, was applied twice daily in accordance with the manufacturer’s instructions. Patients were assessed when treatment was initiated (visit 1), with subsequent assessments after 2 to 3 months of treatment (visit 2), and at the end of the study after 4 to 5 months of treatment (visit 3). Treatment records were kept for all 3 visits.
At each visit, the treating physician evaluated the extent of scar formation with regard to pliability (consistency/hardness), color (redness), sensation, and size. Pliability was rated as one of the following: normal skin, slightly hardened, or markedly hardened. Color was rated as pale/skin-colored, slightly red, or markedly red. Skin sensation with respect to pain, tension, and pruritus could be rated as sensitive to pain, tight, or itchy. At visit 2, patients were asked to provide subjective ratings of the properties of the medication in terms of smell (pleasant, neutral, or unpleasant), spreadability (very good, moderate, or bad), absorption (rapidly absorbed, is absorbed, or is absorbed slowly), and skin sensation after application (improved, unchanged, or worse). Efficacy and tolerability of the treatment were rated at visits 2 and 3 by both the physician and the patient using a 4-point scale (4 = very good, 3 = good, 2 = moderate, 1 = poor). Any adverse drug reactions were also recorded.
Results for color, pliability, sensation of pain, tension, and pruritus at both visits 2 and 3 were analyzed in comparison with those obtained at visit 1, using the McNemar 2-sided test.
Patient Demographics and Characteristics
Figure 1 shows the assessment of scar color (redness) and pliability (consistency/hardness) at each visit. At visit 2, there was a statistically significant improvement in both scar color and pliability compared with visit 1 (P<.0001 for both parameters); a further improvement was seen at visit 3, which was also significant compared with visit 1 (P<.0001 for both parameters). At treatment initiation (visit 1), 45.7% of lesions were rated as markedly red and 32.2% as markedly hardened, but at visit 2, the percentage of scars rated as markedly red had decreased to 3.6% and those rated as markedly hardened had decreased to 4.7%. By the end of the observation period (visit 3), there had been a further improvement, with only 1% of scars being classified as markedly red and 0.9% of scars being classified as markedly hard (Figure 1). In addition, 56.9% of scars had a normal consistency and 67.3% were similar in color to that of normal, healthy skin by the end of the observation period.
Reductions in both scar width and scar height, from visit 1 to visit 3, could be demonstrated in this study. Specifically, mean scar width decreased by 31.5% (from 8.9 mm to 6.1 mm), and mean scar height diminished by 47.8% (from 2.3 mm to 1.2 mm) (Figure 2).