Scar Treatment

We have all had scars at one point in our lives, ranging from the results of a skinned knee to a severe, painful and disfiguring keloid scar.  Sometimes when skin is wounded, the blood clots and the area becomes inflamed. Inflammatory cells produce substances called cytokines including TGF-ß (transforming growth factor-beta) are produced which stimulate fibroblasts and increase collagen production to heal the damaged area. Excessive collagen production results in a hypertrophic scar or keloid.   
 keloid scar
Figure 1.  Example of a Keloid scar 
Collagen is good.  It is the main substrate or support structure under the skin.  The body relies heavily upon estrogen to maintain collagen. That is why older people sometimes develop thin and brittle skin:  lack of estrogen leads to lack of collage which leads to thin skin.  However, when inflammation causes collagen to build to levels beyond those normal for healthy skin function or when collagen becomes mis-formed, scarring results. 
Recently, Professional Compounding Centers of America developed a new scar treatment called PracaSil-Plus.  PracaSil-Plus is a proprietary anhydrous silicone base designed to be applied topically in scar therapy treatment (PCCA, 2013a). Silicones have been widely used for their occlusion and hydration properties, which are essential in scar management (Widgerow et al., 2000; Mustoe, 2008). PracaSil-Plus also contains Pracaxi oil, extracted from the oilseed plant Pentaclethra macroloba, which has several medicinal applications including skin regeneration and healing (Costa et al., 2013). PracaSil-Plus may be used alone or as a base for the incorporation of active substances in scar therapy treatment (PCCA, 2013a). 
Things that Keystone Pharmacy sometimes adds to ParcaSil-Plus include:
Pentoxifylline (0.1 – 0.5% Topically)
  • Decreases collagen production
  • Increases activity of collagenase in dermis
  • Inhibits fibroblast hyperactivity
Salicylic Acid (2—5%)
  • Decreases Inflammation
  • Increases skin turnover
Tamoxifen(1—2%)
  • Decreases estrogen dependent collagen production
Verapamil (5—10%)
  • Decreases calcium channel dependent collage production
Levocetirizine (0.5 – 2%) (Antihistamine)
  • Suppresses stimulation in keloid strains
  • Suppresses collagen synthesis of fibroblasts
Tranilast (0.5 – 2%)
  • Anti-allergic agent that blocks the release of chemical mediators, such as histamine and leukotrienes, from mast cells
EGCg (0.1 – 0.5%)
  • Antioxidant
Caffeine (0.1 – 1%)
  • Induces differentiation and proliferation in epidermal keratinocytes
Collagenase
  • Reduces collagen production

Retinoic Acid (Not for use during pregnancy)

  • 0.05-1%
  • May require physician oversight
Lidocaine (5—10%)
  • Relieves Pain
Ketamine (5—10%)
  • Relieves Pain
Ketoprofen (10—20%)
  • Reduces Inflammation
Efficacy Case Studies
There have been numerous case studies involving the efficacy of PracaSil-Plus.  Below is one that demonstrates the potential efficacy of these formulations in treating hypertrophic scars.
Case Description (1): A type 1 diabetic 57-year-old woman fractured her ankle during a ski accident in March 2009. The patient underwent three reconstructive surgeries between 2009 and 2012, which resulted in three ankle scars. After the application of different products, the patient was still unsatisfied with the resulting
unaesthetic scars. In April 2013, it was suggested the patient apply PracaSil-Plus twice daily on the old scars. Figures 1 and 2 (below) show the overall appearancee of one of the patient’s old scars, before (left) and one week after (right) the application of PracaSil-Plus. 
Patient Report: In only one week I had incredible improvements in the overall appearance of my scars. The thickness almost completely disappeared, the dark color faded and the skin softened. I am very impressed with the results obtained.
 ankle scar
Figure 2. Patient old ankle scar (before PracaSil-Plus)
 ankle scar 2
Figure 3. Patient old ankle scar  (one week after PracaSil-Plus)
References:
Battiston B., Vasario G., Ciclamini D., Rollero L., Tos P. (2013) Reconstruction of traumatic losses of substance at the elbow,Injury, http://dx.doi.org/10.1016/j.injury.2013.09.029
Costa, M., Muniz, M., Negrao, C., Costa, C., Lamarao, M., Morais, L., Junior, J. and Costa, R. language translate (2013) ‘Characterization of Pentaclethra macroloba oil’, Journal of Thermal Analysis and Calorimetry, 16 January 2013 [Online].
Mustoe, T. (2008) ‘Evolution of silicone therapy and mechanism of action in scar management’, Aesthetic Plastic Surgery, 32 (1), p.82-92. 
PCCA (2013a) PracaSil-Plus. Available at: http://www.pccarx.com/pccaproducts/pcca-exclusives/bases/PracaSilplus (Accessed: 17 May 2013).
PCCA (2013b) ‘Efficacy of PracaSil-Plus in scar therapy treatment: a randomized,double-blind, controlled pilot trial’, Technical Report: 2TR0513. 
Widgerow, A., Chait, L., Stals, R. and Stals, P. (2000) ‘New innovations in scar management’, Aesthetic Plastic Surgery, 24(3) p 
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3 Responses to Scar Treatment

  1. Where do you buy this and how much is it? I had open heart surgery and have a big scar.

    • Keystone says:

      Pracasil requires a prescription from your provider and is available at select compounding pharmacies including Keystone Pharmacy. The base along has improved scars but adding active ingredients will make the base more effective. Your provider can call our pharmacists and inquire as to what they would advise for you.
      A 30g tube is $51.90
      60gram tube is $73.80

      Please come to our presentation on the 29th, regarding Innovations in Scar Therapy; http://www.keystonerx.com/news-and-events/#pracasil.

  2. I have had 5 facial surgeries because of a injury to my nose. I have 5 scars on my face and 1 scar from the middle of my eyes all the way up to where my hair line starts. I cant go outside with out a beanie on my head and a nose cover. I need something that will help diminish the appearance of these awful scars. Please let me know something soon.

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