Though they rarely prompt clinic visits, scars often compel individuals to ask their dermatologist about interventions to lessen their appearance or quicken healing. Laser therapy is one option, but most people want a topical intervention. Despite the bevy of products for scars sold, effective agents are rare. Ahead, Alan Fleischer, MD, Executive Director of Dermatology at Merz USA, shares insights on scarring in dermatology and the role of one particular agent that has proven effective.

Can you share your impressions of OTC agents for the treatment of general scarring?

According to Dr. Fleischer, a large number of products available for scarring have not been studied or shown to provide any real benefit. “Essentially, most of these cosmetic products are whipped up in a lab and then put on the market with fancy packaging,” says Dr. Fleischer. “Topical agents for scarring represents a general area that lacks scientific rigor in the evaluation of products,” he continues. Dermatologists may be generally blase toward scarring. However, he says, “the common nature of scarring and the proliferation of products indicates that the appearance of scars is of some cosmetic importance to the public.”

One agent has been studied and is shown to be beneficial for general scarring, including stretch marks, notes Dr. Fleischer. Onion extract gel (Mederma, Merz) has been clinically tested and shown to be effective in reducing the appearance of scars, he observes. “The evidence indicated that onion extract gel is effective in a majority of patients after eight weeks of daily application,” says Dr. Fleischer. Roughly three out of every four patients receiving Mederma Scar Gel in one trial showed quite significant improvements, with scars being significantly softer and less noticeable, says Dr. Fleischer.

How significant a role can onion extract play in the treatment of scars?

There appears to be some bias against botanical products in therapy because many of these products lack strong scientific inquiry, according to Dr. Fleischer. “However, botanical agents can have true therapeutic value, as a fair number of pharmacologic formulations incorporate botanical elements,” he says. The strong clinical outcomes for Mederma in clinical trials lend credence to this fact.

While onion extract may not be the solution for deeper and hypertrophic scars, it can be beneficial as an adjunct to other treatment, as well, Dr. Fleischer suggests. “Another component of a clinically proven topical agent such as Mederma is that it allows patients to participate in the process of their care,” says Dr. Fleischer. Certainly, having some clinical evaluation increases the likelihood of positive outcomes, but it also may allow patients to feel like they are playing an active part in the healing of their scar. This, according to Dr. Fleischer, may increase compliance.

In order to see the effects of the product, patients will need to apply it for eight weeks, which can be a long time for patients. But according to Dr. Fleischer, it's important to note that the duration of the wound healing process takes well in excess of a year. “Therefore, empowering patients to be part of the process gives them a useful activity while they're waiting for results,” says Dr. Fleischer. He adds, “also, compliance in daily application can influence the result to optimize scar appearance. Patients should be involved and committed to treating the scar and realize that it is not a ‘quick fix' remedy.”

What is your assessment of clinical research on onion extract gel for stretch marks?

The development of stretch marks during pregnancy is nearly universal, notes Dr. Fleischer. Therefore, many women who have given birth are interested in products to reduce their appearance. According to Dr. Fleischer, Mederma Stretch Marks Therapy (Merz, based on the same onion extract as Mederma) has shown to be equally beneficial as the scarring product in reducing discoloration and significantly decreasing the appearance of stretch marks. “One particular controlled trial indicated clearly that those on the Mederma Stretch Marks Therapy side were significantly improved, as compared to the side not using Stretch Marks Therapy,” says Dr. Fleischer.

Stretch Marks Therapy can also be useful in pediatric populationis, Dr. Fleischer explains. “Particularly in the teen population, Mederma's Stretch Marks Therapy can be beneficial for those whose body tissue outstretches the skin's ability to keep up,” he says. While pregnant women may anticipate stretch marks, teens tend to be more surprised when stretch marks appear on their skin, according to Dr. Fleischer.

As with pregnant women, teenagers will not likely visit a dermatologist primarily to have their stretch marks assessed and treated. “It's relatively uncommon for people to present solely because of their stretch marks,” says Dr. Fleischer. “But that doesn't lessen the concern that many teens and pregnant or formerly pregnant women have regarding how to best address these stretch marks,” he continues. Dr. Fleischer recommends that physicians maintain an awareness of stretch marks and other scars.

What else should patients know about treatment?

“The trials for this product clearly show that it makes a significant difference compared to not using it,” Dr. Fleischer observes. “If you are going to spend eight weeks using a product, it should be a product that works with demonstrated efficacy.” The challenge, then, is to ensure that consumers are informed about these facts, as well.