Clinical evidence is lacking to support the use of silicone gel sheeting (SGS) for patients with hypertrophic scars compared with other treatments, according to study findings published in the Cochrane Database of Systematic Reviews.
Investigators conducted a search of all relevant clinical trials regarding use of SGS for hypertrophic scars in the Cochrane Wounds Specialised Register, the Cochrane Central Register of Controlled Trials via the Cochrane Register of Studies, Ovid MEDLINE (1946 to April 21, 2021), Ovid Embase (1974 to April 21, 2021), and EBSCO CINAHL Plus (1937 to April 21, 2021), as well as clinical trials registries.
A total of 13 studies with 468 patients (425 participants completed the study) were included in the analysis. Comparisons were reported for SGS vs no SGS treatment and SGS compared with pressure garments; silicone gel; topical onion extract; polyurethane; propylene glycol and hydroxyethyl cellulose sheeting; Kenalog injection; flashlamp-pumped pulsed-dye laser; intense pulsed light; and Gecko Nanoplast.
The primary outcome was scar severity as assessed by health care professionals, although 9 of 13 studies and half of the comparisons did not report data for this outcome, it was noted.
A total of 7 studies with 177 participants compared SGS with no SGS. Based on 2 studies that reported scarring severity assessed by health care professionals, it was uncertain whether there was a difference in scarring severity between the 2 groups (mean difference [MD] –1.83; 95% CI, –3.77 to 0.12; very low-certainty evidence). According to the researchers, 1 study suggests that SGS may result in a slight reduction in pain level compared with no SGS treatment (MD −1.26; 95% CI, −2.26 to −0.26; low-certainty evidence).
For SGS compared with pressure garments, 1 study found that SGS may reduce pain levels (MD −1.90; 95% CI, −2.99 to −0.81; low-certainty evidence). Based on 1 study that compared SGS with silicone gel, it was unclear whether SGS affects scarring severity (MD 0.40; 95% CI, −0.88 to 1.68; very low-certainty evidence).
For SGS compared with topical onion extract, 1 trial with 32 participants found that SGS may slightly reduce scarring severity (MD –1.30; 95% CI, –2.58 to –0.02; low-certainty evidence).
It was unclear if SGS affects the severity of scarring compared with polyurethane in 1 study (MD 0.50; 95% CI, –2.96 to 3.96; very low-certainty evidence), and it was uncertain if SGS reduces pain compared with self-adhesive propylene glycol and hydroxyethyl cellulose sheeting in 1 study (MD −0.12; 95% CI, −0.18 to −0.06; very low-certainty evidence).
In addition, it was unclear whether SGS improves pain compared with Gecko Nanoplast based on 1 study (MD 0.70; 95% CI, –0.28 to 1.68; very low-certainty evidence).
Comparisons of SGS with Kenalog injection, flashlamp-pumped pulsed-dye laser, and intense pulsed light did not report usable data.
“None of the included studies provided evidence on severity of scarring validated by participants, health-related quality of life, or cost effectiveness,” stated the investigators. “Reporting was poor, to the extent that we are not confident that most trials are free from risk of bias.”
Jiang Q, Chen J, Tian F, Liu Z. Silicone gel sheeting for treating hypertrophic scars. Cochrane Database Syst Rev. 2021;9:CD013357. doi: 10.1002/14651858.CD013357.pub2