Scarring in the skin after surgery or accidental injury is a common medical problem. There are estimated to be approximately 44 million surgical procedures per year in the United States (unpublished data, Mattson Jack Group) and 42 million in the European Union (unpublished data, MedTech Insights and TforG) that could benefit from scar-reduction therapy.1 A recent survey of 97 patients and 24 clinicians revealed that patients were dissatisfied with the appearance of their scars resulting from surgery, irrespective of gender, age, and ethnicity. Furthermore, 91% of patients surveyed reported that they would value even a small improvement in scarring.2 These findings are supported by the large number of patients who seek scar revision surgery each year (a total of 171,000 patients in the United States in 2009).3
It is known that patients suffer both physically and psychologically as a result of scarring. Physical suffering often occurs when scars negatively affect functionality, especially when located over a joint. The lack of elasticity may severely impede mobility. This is particularly common after extensive injuries to the skin and softer tissue from burns or inflammation.
Severe scarring may also affect patients psychologically. Larger scar size has been significantly associated with self-consciousness and anxiety levels in patients with only minor facial injuries.4 In 50 patients who had suffered facial trauma, there was a significant positive correlation between patientsâ€™ self-perception of facial disfigurement scores and scores obtained in both the anxiety and depression subscales of the Hospital Anxiety and Depression Scale.5 One-quarter of patients with a scar from congenital heart disease surgery (sternotomy, thoracotomy, or both) â€œdid not likeâ€ or â€œhatedâ€ their scars.6
Despite the great need for effective therapies, scar treatment remains challenging. A wide variety of approaches have been employed, from the invasive (steroid injections, cryotherapy, and surgery) to the noninvasive (silicone gel sheeting, pressure garments, hydrating creams, and ointments).1,7 To date, a combination including various approaches is frequently favored.8 However, even today, established scars are particularly difficult to treat and effective prophylaxis remains of crucial importance. Options for prophylactic therapy are limited, but specific topical medications containing appropriate active substances are fre-