Some of the most expensive scar treatments on the market deliver the least benefit, with cheaper moisturisers outperforming high-priced silicone gels and oils in restoring skin hydration and barrier function, an Australian study has found.
Using a validated tape-stripping model to replicate damaged skin, the team found simple moisturisers provided equal or greater benefit than their costly silicone-based counterparts, underscoring the importance of evidence over marketing in scar management.
“Our findings highlight that higher cost does not necessarily correlate with superior outcomes,” report investigators from University of Adelaide and the Royal Adelaide Hospital.
“We tell recovering patients about the importance of massage, moisturising and using pressure garments – there are evidence-based guidelines around best practice for massage and compression, but moisturiser is something that remains up to each clinician,” explains lead author Tanja Klotz, PhD candidate and Occupational Therapist with the Royal Adelaide Hospital’s burns unit.
“We found that there was significant variability in the effectiveness of common moisturisers clinicians recommend for scar management.”
Eight products commonly recommended for hypertrophic scar care were tested over four hours on 30 healthy participants using tape-stripped skin as a surrogate model. Eucerin Advanced Repair Cream, an American product which can be purchased online, ranked highest overall for improving hydration and normalising transepidermal water loss (TEWL), a key indicator of barrier repair.
Eucerin was identified as the most effective moisturiser, the researchers found, attributing its efficacy to the presence of glycerine and urea.
“Eucerin efficacy in increasing hydration can be attributed not only to its formulation as an oil-in-water emulsion but also to the presence of glycerine and urea as the primary active ingredients after water,” says Miss Klotz.
Redwin Sorbolene, a pharmacy and supermarket staple, ranked third in overall performance, demonstrating “strong efficacy in increasing hydration and normalising transepidermal water loss”. QV Lotion also performed well in boosting hydration, though its effect on TEWL was more modest.
In contrast, the lowest-performing products – Alhydran, Strataderm, and Bio-Oil – were also the three most expensive.
Strataderm, a silicone-based scar gel marketed for use in burns and plastic surgery aftercare, failed to improve hydration and instead increased TEWL in some measurements. The authors noted that Strataderm is composed entirely of emollients and likely lacks sufficient humectants, such as glycerine or urea, to attract moisture into the skin.
“Silicone gel sheets are widely used to manage scars and are made of a soft, flexible silicone material which is designed to provide a barrier against TEWL. The evidence base for the use of these is extensive. We were surprised that the gel sheets had a high hydration level, but also recorded a high TEWL due to all the hydration evaporating on removal, while a liquid silicone gel performed poorly for improving hydration and reducing TEWL,” Ms Klotz said.
Bio-Oil, a heavily marketed cosmetic oil, delivered similarly poor results. It showed negligible improvements in hydration and was the only product that increased TEWL.
The authors suggest its formulation may also be to blame, with humectants likely present in such small quantities that they are unable to deliver meaningful moisturising effects.
“Bio-Oil similarly predominantly consists of emollients and the humectants are likely in such small proportions, resulting in the lack of hydrating effect seen in this study.”
Alhydran produced an unusual result – while it did help normalise TEWL, it significantly reduced hydration, performing worse than untreated tape-stripped skin. This contrasted with previous studies and may be related to a suppression of the skin’s histaminergic response, which can increase hydration via local oedema following barrier damage, investigators suggest.
“Although Alhydran demonstrated effectiveness in normalising TEWL, it was associated with a decrease in skin hydration which is suboptimal,” the authors said.
The researchers acknowledged this finding was inconsistent with earlier trials and highlighted the need for further investigation.
Silicone gel sheets, meanwhile, produced high hydration levels during application but caused elevated TEWL immediately after removal – a factor likely due to rapid evaporation of retained moisture, say investigators who note that these products may induce a “hyperhydration state,” making TEWL measurements less reliable post-removal.
Overall, the researchers concluded that moisturisers combining humectants, emollients, and occlusives provided the strongest evidence of benefit and often at significantly lower cost than specialist scar products.
“This study offers evidence-based guidance for clinicians and highlights the need for further research to optimise formulations for scar management,” they said.
They added that future trials should expand to include more product formats, such as thicker creams versus lotions, and test moisturisers directly on active scar tissue, rather than simulated models, to better reflect real-world clinical outcomes.
The study was published inBurns [link here].