Occlusive dressings

Occlusive dressings for keloid and hypertrophic scars include:

• silicone gel sheeting
• non-silicone occlusive sheeting
• steroid-impregnated tape

On a molecular level, it is unclear how this modality works. Suggestions include hydration of the scar and the activation of enzymes by a relative increase in temperature within the wound. Steroid tape dampens the local inflammatory and immune response.

Silicone gel sheeting is thought to be effective at reducing the elevation and activity of fibroproliferative scars. It may be more effective for hypertrophic than keloid scars. The sheets need to be applied for prolonged periods - at least 12 hours - every day, and patients often find them most convenient to wear at night. Up to three quarters of patients of patients with hypertrophic scars had improvement of pain, pruritus and erythema when worn continuously for one year.

Pressure garments, an adjunctive treatment for such scars, are effective at keeping the sheeting in place. However, problems with sheeting include:

• poor patient compliance over visible sites such as the face
• maceration and itching of the skin on hot days
• rarely, skin ulceration