Scarring is a natural part of the healing process after injury, and can occur from surgery, burns, and other types of trauma. Scars develop differently from one person to the next. Factors that characterize the type of scar may include the depth, size, and location of the injury or wound. Our compounding staff is able to combine multiple medications into a single customized cream that can work locally to minimize the appearance of scars, or even prevent the appearance of scars.
Common types of scars:
- Keloid Scars: This type of scar can be a result of an overly aggressive healing process. They are often raised scars and can sometimes hinder movement for a patient.
- Contracture Scars: Normally result from skin that has been burned. This type of scar can cause the patient to have difficulty moving as the contracture scar often tightens skin. It may also affect nerves and muscles.
- Hypertrophic Scars: A raised and red scar, similar to a keloid scar, but different in that it stays within the boundaries of the injury site.
- Acne Scars: A very common type of scar that results from severe to moderate acne. Some acne scars are wavelike in appearance.
Our compounding staff is able to combine several different medications into a customized cream that may be able to work locally to minimize the appearance of scars or even prevent the appearance of scars.
- PCCA PracaSil-Plus is a unique topical anhydrous silicone base that can be used alone or with various active ingredients for potential use in formulations. It is the only compounding base designed specifically for scars. It is the ideal choice for new scars, old scars, surgical scars, keloids, stretch marks, and acne scars. PracaSil-Plus contains Pracaxi oil derived from the seed of the Pracaxi tree found in the Amazon rainforest. This is a unique ingredient with anti-inflammatory, antioxidant, antibacterial, and antifungal properties. It is also designed to create a resilient film on the skin, so that the scar receives as much exposure to the active ingredients as possible.
- Tranilast is an anti-allergic drug that has been shown to inhibit the release of histamine and prostaglandins from mast cells. It also suppresses collagen synthesis of fibroblasts derived from keloid and hypertrophic scar tissue but not healthy tissue. Tranilast also inhibits the release of transforming growth factor (TGF)- beta 1 from keloid fibroblasts.
- Glucocorticoids such as fluticasone,mometasone, and betamethasone are used to reduce inflammation. They cause a reduction in fibroblast proliferation and collagen deposition. They also have various antipruritic and vasoconstrictive properties.
- Levocetirizine is a histamine (H1) receptor antagonist. Topical antihistamines can be used to reduce swelling and eliminate itching. They also may inhibit the inflammatory response which reduces scar formation. They are also antiproliferative agents and may have been shown to inhibit the deposition and synthesis of collagen in keloid fibroblasts through suppression of the release of TGF-beta 1 from fibroblasts. Levocetirizine is a long-acting antihistamine which provides for less frequent dosing and longer relief for patients.
- Verapamil and Nifedipine are calcium channel blockers/vasodilators. Calcium is responsible for fibroblast, which produce collagen, an important part of skin tissue growth. Fibroblasts also produce collagenase, which breaks down collagen. The calcium channel blockers decrease collagen and increase collagenase, thereby breaking down scar tissue and halting its growth.
- Pentoxifylline increases blood flow in the peripheral blood vessels. Pentoxifylline also blocks transforming growth factor (TGF)-beta 1, and enzyme which plays a role in cell growth, and decreases the formation of collagen.
- Tamoxifen is a non-steroidal anti-estrogen that improves wound healing in keloids by decreasing the expression of TGF-beta1 and consequently inhibiting fibroblast proliferation and collagen production.
- Collagenase provides hydrolysis of pathological collagen and hyaluronic acid and recovery of normal composition and structure of extracellular matrix.
- Caffeine is often used in older scars as it inhibits proliferation and induces apoptosis of fibroblasts in hypertrophic scars by activation of p53 and inhibition of Akt activation.
- Tretinoin is often used in treating stretch marks. It has been shown to improve the chronic inflammation that is seen in keloid scars and prevents the expansion of tissues into surrounding normal skin.
As one can see, there are a variety of options that are available to treat scars. This is not an exhaustive list as there are other medications that can be incorporated into formulas to help in the treatment. Our compounding team will work with the prescriber to find the formula that works best for each individual patient.