The Effect of Moisturisers on Scars: a Systematic Review

Total Page:16

File Type:pdf, Size:1020Kb

The Effect of Moisturisers on Scars: a Systematic Review The effect of moisturisers on scars: a systematic review. Submitted by Tanja Klotz, BAppSc(OT), BSc Thesis submitted in fulfilment of the requirements for the degree of Master of Clinical Science Joanna Briggs Institute, Faculty of Health and Medical Sciences, The University of Adelaide 2018 i Contents Contents ...................................................................................................................................... ii List of figures and tables ............................................................................................................ iv Thesis declaration ....................................................................................................................... v Acknowledgements .................................................................................................................... vi Abstract ..................................................................................................................................... vii 1. Introduction ........................................................................................................................... 10 1.1 Context of the review .......................................................................................................... 10 1.2 The need for this systematic review .................................................................................... 11 1.3 Skin and scar formation ...................................................................................................... 11 1.3.1 Skin .............................................................................................................................. 11 1.3.2 Wound healing and scar formation .............................................................................. 12 1.3.3 Trans-epidermal water loss, hydration and occlusion: its relationship to scar formation ............................................................................................................................................... 12 1.4 Types of scars...................................................................................................................... 13 1.4.1 Linear scars .................................................................................................................. 13 1.4.2 Hypertrophic scars ....................................................................................................... 14 1.4.3 Keloid scars .................................................................................................................. 15 1.4.4 Atrophic scars .............................................................................................................. 15 1.5 Scar management ................................................................................................................ 16 1.6 Moisturisers ......................................................................................................................... 16 1.6.1 Characterising moisturisers by type and availability ................................................... 17 1.7 The science of evidence synthesis ...................................................................................... 25 2. Methodology and method ..................................................................................................... 27 2.1 Review question ............................................................................................................. 27 2.2 Criteria for considering studies for inclusion in this review .......................................... 27 2.2.1 Types of studies ...................................................................................................... 27 2.2.2 Types of participants ............................................................................................... 27 2.2.3 Types of interventions ............................................................................................. 28 2.2.4 Comparators ............................................................................................................ 28 2.2.5 Types of outcome measures .................................................................................... 29 2.3 Review methods ............................................................................................................. 29 2.3.1 Search strategy ........................................................................................................ 29 2.3.2 Study selection and inclusion .................................................................................. 32 2.3.3 Assessment of methodological quality – critical appraisal ..................................... 32 ii 2.3.4 Data extraction ........................................................................................................ 33 2.3.5 Data synthesis .......................................................................................................... 33 3. Results of searching, selection and assessment of methodological quality .......................... 35 3.1 Results of searches.......................................................................................................... 35 3.1.1 Other searches ......................................................................................................... 35 3.2 Screening of studies ........................................................................................................ 36 3.3 Excluded studies ............................................................................................................. 37 3.4 Included studies .............................................................................................................. 37 3.4.1 Included studies: moisturiser group ........................................................................ 37 3.4.2 Included studies: imiquimod group ......................................................................... 39 3.5 Critical appraisal ............................................................................................................. 55 3.5.1 Methodological quality of included studies – moisturiser group ............................ 55 3.5.2 Methodological quality of included studies – imiquimod group ............................ 61 4. Review findings ..................................................................................................................... 63 Narrative synthesis of the effect of moisturisers on scars ......................................................... 63 4.1 Cosmesis of the scar ....................................................................................................... 63 4.2 Scar parameters ............................................................................................................... 66 4.3 Itch and pain ................................................................................................................... 72 4.4 Trans-epidermal water loss and hydration...................................................................... 76 4.5 In vitro outcomes ............................................................................................................ 76 4.6 Recurrence of excised keloids treated with 5% imiquimod – a meta-analysis .............. 79 4.6.1 Meta-analysis of all included studies in imiquimod group ..................................... 79 4.6.2 Meta-analysis – surgical technique ......................................................................... 80 4.6.3 Meta-analysis – location of keloid .......................................................................... 83 4.7 Adverse events ................................................................................................................ 85 5. Discussion and conclusions ................................................................................................... 87 5.1 Effect of moisturisers on outcomes ................................................................................ 87 5.2 Assumptions, limitations and delimitations ........................................................................ 98 5.3 Implications for research .................................................................................................... 99 5.4 Conclusions ....................................................................................................................... 101 References ................................................................................................................................... 102 Appendices .................................................................................................................................. 109 Appendix 1: Logic grids for database searching ..................................................................... 109 Appendix 2: Critical appraisal tools ........................................................................................ 113 Appendix 3: Excluded studies and reasons for their exclusion ............................................... 117 iii List of figures and tables Table 1-1: Australian availability to consumers of products examined in this systematic review18 Table 1-2: Cost and usual available sizes of prescription only creams ........................................ 19 Table 1-3 Cost and usual available size of high cost over the counter creams. Prices obtained by basic internet searching in January 2018. ....................................................................................
Recommended publications
  • Love Plasma Price List 4 Other Treatments
    PLASMA UPPER FACIAL TREATMENTS NECK LIFT / TURKEY NECK £650 NECK LINES / NECK CORDS £350 WRINKLED HANDS £400 (5-8 TREATMENTS, OVERALL FACIAL RESURFACING & REJUVENATION 2 TO 3 WEEKS APART) £700 SKIN TAGS FROM £50 NON-SURGICAL FACELIFT (FULL, MID, MINI) OVERALL FACIAL RESURFACING & REJUVENATION NECK LIFT, TURKEY NECK, NECK LINES / NECK CORDS / BANDING WRINKLED HANDS WWW.LOVEPLASMA.COM PLASMA LOWER FACIAL TREATMENTS JOWL / JAWLINE TIGHTENING & AUGMENTATION £500 VERTICAL LINES / SMOKERS LINES / PERIORAL LINES LIPSTICK LINES £250 SMILE LINES / MARIONETTE LINES £250 LABIOMENTAL CREASE / CHIN LINES £250 LIP FLIP £200 PHILITRAL CREST, VERTICAL LIP LINES / SMOKERS LINES / PERIORAL LINES / PERITONEAL FOLDS / LIPSTICK LINES ORAL COMMISSURES / MOUTH CORNERS SMILE LINES / PARENTHESES JOWL / JAWLINE TIGHTENING & MARIONETTE LINES & AUGMENTATION LABIOMENTAL CREASE, CHIN LINES & CHIN AUGMENTATION WWW.LOVEPLASMA.COM PLASMA MID FACIAL TREATMENTS HORIZONTAL LINES / BUNNY LINES £150 EAR LOBE REJUVENATION £150 NASOLABIAL FOLDS £250 ACCORDION LINES & FOLDS £200 HORIZONTAL LINES / BUNNY LINES & RHINOPHYMA CHEEK LIFT, SKIN TENSION LINES, NASOLABIAL FOLDS ROSACEA & FACIAL REJUVENATION ACCORDION LINES & FOLDS WWW.LOVEPLASMA.COM PLASMA UPPER FACIAL TREATMENTS CROWS FEET £250 NON SURGICAL BLEPHAROPLASTY UPPER EYELIDS £250 NON SURGICAL BLEPHAROPLASTY LOWER EYELIDS £200 NON SURGICAL BLEPHAROPLASTY UPPER & LOWER EYELIDS £430 EYEBROW LIFT £300 HOLLOW TEMPLES CROWS FEET PREORBITAL REGION AND INFRAORBITAL FOLDS / CREASES FROWN / RELAX LINES / CREASES NON-SURGICAL GLABELLA AREA, BETWEEN THE BROW / BLEPHAROPLASTY FOR RADIX UPPER & LOWER EYELIDS / BAGS / HOODS WWW.LOVEPLASMA.COM.
    [Show full text]
  • EMBRACE YOUR SCARS a SCAR Is Your Skin’S Natural Way of Knitting Itself Back Worry About Scars? Together After It’S Been Hurt
    ASK THE Experts own skin. We asked two of our Skin Cancer Founda- Mohs surgery on certain cases of melanoma, but tion member physicians to share their expertise on this requires additional training. Patients with more Healing everything you need to know to be scar-savvy, from advanced melanomas may require additional treat- wound care to scar repair. ments, such as radiation or medications, including immunotherapies and targeted therapies. What is a scar, exactly? How much do patients EMBRACE YOUR SCARS A SCAR is your skin’s natural way of knitting itself back worry about scars? together after it’s been hurt. Healing is a multipart pro- If you have a scar, congratulations! Think of it as a badge of courage and healing. cess, and the science behind it is complex. Dermatolog- WHEN DOCTORS tell patients they need skin cancer Our expert dermatologists tell how to nurture a new scar to get the ic surgeon Mary-Margaret Kober, MD, who practices surgery, they hear a wide range of reactions, says Dr. in Santa Rosa, California, helps explain it in simple Kober. “I have some patients who say, ‘I don’t care best outcome — and, if needed, how to fix an old scar to make it look better. terms. Wherever there’s been an injury, she says, the about the scar, Doc. I don’t have a modeling career. by Julie Bain first thing that happens is that blood cells called plate- Just get the cancer out.’ That’s one extreme.” There lets gather together and form a clot to stop the bleed- are also patients on the other side of the spectrum, ing and seal the wound.
    [Show full text]
  • Sunday, 11 April 2021 John 20:19-31 Pr Gus Schutz 'Then He Said
    Sunday, 11 April 2021 John 20:19-31 Pr Gus Schutz ‘Then he said to Thomas, “Put your finger here; see my hands. Reach out your hand and put it into my side. Stop doubting and believe.”’ The scars of Jesus were very important for Thomas. It can be easy to be a little hard on Thomas. I think tradition has done that. Put yourself in his situation. Wouldn’t you also want some visible proof to connect what you see with the events of Good Friday? So that you can know without doubt that this really is the same Jesus who was hung up on the cross? The truth is the scars of Jesus were important for all the disciples. They confirmed to them that it truly was Jesus. In the same body, now risen and transformed. • When Jesus first appeared to the disciples, Luke tells us: “they were startled and frightened and thought they saw a spirit.” (Luke 24:37) Then he showed them his scars, saying to them: “Look at my hands and my feet. It is I myself! Touch me and see; a ghost does not have flesh and bones, as you see I have.” (Luke 24:39) • The apostle John reports that Jesus: “showed them his hands and feet” (John 20:20) This was the first time, when Thomas was not with them. So he insisted he must see the scars when it was reported to him that the others had seen Jesus. Eight days later the wish and prayer of Thomas was answered. Jesus offered him his scars, saying: “Put your finger here; see my hands.
    [Show full text]
  • Blepharoplasty Consent Form
    Patient Name (ID): D.O.B.: Date: BLEPHAROPLASTY CONSENT FORM As you age, the skin and muscles of your eyelids and eyebrows may sag and droop. You may get a lump in the eyelid due to normal fat around your eye that begins to show under the skin. These changes can lead to other problems. For example: • Excess skin on your upper eyelid can block your central vision (what you see in the middle when you look straight ahead) and your peripheral vision (what you see on the sides when you look straight ahead). Your forehead might get tired from trying to keep your eyelids open. The skin on your upper eyelid may get irritated. • Loose skin and fat in the lower lid can create "bags" under the eyes that are accentuated by drooping of your cheeks with age. Many people think these bags look unattractive and make them seem older or chronically tired. Upper or Lower Blepharoplasty (eyelid surgery) can help correct these problems. Patients often refer to this surgery as an "eyelid tuck" or "eyelid lift." Please know that the eyelid itself may not be lifted during this type of surgery, but instead the heaviness of the upper eyelids and/or puffiness of the lower eyelids are usually improved. Ophthalmologists (eye surgeons) call this surgery "blepharoplasty." The ophthalmologist may remove or change the position of skin, muscle, and fat. Surgery may be on your upper eyelid, lower eyelid, or both eyelids. The ophthalmologist will put sutures (stitches) in your eyelid to close the incision (cut). • For the upper lid, the doctor makes an incision in your eyelid's natural crease.
    [Show full text]
  • Eyelid Surgery (Blepharoplasty)
    Eyelid Surgery (Blepharoplasty) Anatomy and Description of Blepharoplasty What is Blepharoplasty? Blepharoplasty refers to eyelid surgery. It is a surgical procedure to remove excess skin and underlying fat from the upper eyelids, lower eyelids or both. Blepharoplasty surgery is customised for every patient, depending on his or her particular needs. It can be performed alone involving upper, lower or both eyelids, or in conjunction with other surgical procedures of the brow or face. Blepharoplasty can diminish excess skin and bagginess in the eyelid region but cannot stop the process of aging. Blepharoplasty will not remove "crow's feet" or other wrinkles, eliminate dark circles under the eyes, or lift sagging eyebrows or upper cheeks. Upper eyelid surgery can help improve vision in older patients who have hooding of skin over the upper eyelids. Eyelid surgery can add an upper eyelid crease to the Asian eyelid but it will not erase the racial or ethnic heritage. Surgical Incisions Incisions in the upper eyelids An incision is made in the natural skin fold of the upper eyelid. The skin fold of the upper eyelid helps to conceal the scar. Excess skin and protruding fat are removed. The incision may be closed with a suture that dissolves or a skin suture that will have to be removed after a few days. Incisions in the lower eyelids There is a choice of two incisions in the lower eyelids. The incision used will depend on the individual surgeon and the underlying eyelid problem. Your surgeon may either choose an external or internal incision and/or laser resurfacing.
    [Show full text]
  • Post-Operative Instructions for Eyelid Surgery
    THE PRE-OPERATIVE SESSION™ PRE-OPERATIVE INSTRUCTIONS FOR BLEPHAROPLASTY SURGERY Please watch the following videos, which correspond with the instructions below: • Pre-op instructions for facial surgeries https://www.youtube.com/watch?v=Xd0aCTXptyk&feature=youtu.be • Post-op instructions for facial surgeries https://www.youtube.com/watch?v=eTuQ0VafhXQ&feature=youtu.be • Instructions for blepharoplasty surgery https://www.youtube.com/watch?v=OFDpzicC6V8 THREE WEEKS BEFORE SURGERY: • If it is required by your surgeon, laboratory tests, EKG and eye exams should be done at this time. If this testing is done at your physician’s office or other location, please fax written results to our office at (585) 271-4786. These results must be received 1 week prior to surgery. • If there is any chance that you are pregnant, surgery will need to be rescheduled. • All fees-surgical, anesthesia and facility are due to our Patient Consultants. TWO WEEKS BEFORE SURGERY: • Discontinue aspirin, ibuprofen (e.g. Advil, Motrin) or any supplements that increase risk for bleeding. Check the label of any OTC medications for aspirin or ibuprofen. Check with your PCP and/or cardiologist before stopping aspirin. • Tylenol is ok to take. • Stop all nicotine products, including any tobacco products, vaping, or nicotine patches since nicotine decreases circulation and may result in a poor outcome. • Start Vitamin C 1000 mg three times per day to improve wound healing. • If your destination after surgery is more than 30 minutes from the office, you must make arrangements to stay locally the night of surgery. Your Patient Consultant can assist with this.
    [Show full text]
  • Impact of Upper Eyelid Surgery on Symptom Severity and Frequency in Benign Essential Blepharospasm
    JMD https://doi.org/10.14802/jmd.20075 / J Mov Disord 2021;14(1):53-59 pISSN 2005-940X / eISSN 2093-4939 ORIGINAL ARTICLE Impact of Upper Eyelid Surgery on Symptom Severity and Frequency in Benign Essential Blepharospasm Hannah Mary Timlin, Kailun Jiang, Daniel George Ezra Blepharospasm Clinic, Moorfields Eye Hospital NHS Foundation Trust, London, UK ABSTRACT ObjectiveaaTo assess the impact of periocular surgery, other than orbicularis stripping, on the severity and frequency of bleph- arospasm symptoms. MethodsaaConsecutive patients with benign essential blepharospasm (BEB) who underwent eyelid/eyebrow surgery with the aim of improving symptoms were retrospectively reviewed over a 5-year period. Patients who had completed the Jankovic Rating Scale (JRS) and Blepharospasm Disability Index (BDI) pre- and at least 3 months postoperatively were included. ResultsaaTwenty-four patients were included. JRS scores significantly improved from 7.0 preoperatively to 4.1 postoperatively (p < 0.001), and BDI scores significantly improved from 18.4 preoperatively to 12.7 postoperatively (p < 0.001); the mean percent- age improvements were 41% and 30%, respectively. Patients were followed for a median of 24 months postoperatively. ConclusionaaPeriocular surgery significantly reduced BEB symptoms in the majority (83%) of patients by an average of 33% and may therefore be offered for suitable patients. An important minority (17%) of patients experienced symptom worsening. Key WordsaaBlepharospasm; Eyelid surgery; Focal dystonia. Benign essential blepharospasm (BEB) is a type of dystonia severity or frequency of symptoms can dramatically improve a that causes excessive involuntary spasms of the orbicularis oc- patient’s quality of life and independence. uli muscle.1 This causes increased blinking, periocular spasms Symptom management most commonly involves chemode- or eyelid closure, which is usually life-long and can be progres- nervation with botulinum toxin injections (BTIs).1 This provides sive.
    [Show full text]
  • Surgical Treatment Options for Lower Eyelid Aging Joe Niamtu III, DMD
    COSMETIC TECHNIQUE Surgical Treatment Options for Lower Eyelid Aging Joe Niamtu III, DMD The lower eyelid and associated anatomy represent a complex structure that is key in facial aging and rejuvenation. There are numerous ways to address this region and some of the more common treat- ment options are discussed in this article. A review is presented of the diagnosis and popular treatment options to address the most common aspects of eyelid aging. The author has performed cosmetic lower eyelid surgery using transconjunctival blepharoplasty with skin resurfacing for the past 12 years, with pleasing results and low complications. Lower eyelid rejuvenation is one of the most commonly requested procedures in a cosmetic surgery practice. A firm understanding of the complex anatomy of this region is paramount to successful treatment. Although many methods exist for addressing this region, some techniques are more prone to postoperative complications. The author has had continued success with hundreds of patients by performing transconjunctival lower eyelid blepharoplasty with CO2 laser resurfacing, chemicalCOS peels, or skin-pinch DERM procedures. These procedures are safe, predictable, and have a place in theDo armamentarium Not of contemporary Copy cosmetic surgeons. ermatochalasis is the crepey, wrinkled, The basis of this article concerns skin aging and its loose, and sun damaged skin of the eye- surgical correction, but discussion of the periorbital fat is lids. Because age-associated changes to germane to the understanding of the aging process and its the upper face often present earlier than correction. The periorbital fat is an essential evolutionary age-associated changes to the lower face, system that serves in part to cushion the globe within its itD is not uncommon for the cosmetic surgery practitioner bony orbit.
    [Show full text]
  • Lower Eyelid Pinch Blepharoplasty
    32_N2e_Rosenfield_r5_bs_969-994.qxd:Volume1 9/28/10 4:10 PM Page 969 CHAPTER 32 Lower Eyelid Pinch Blepharoplasty LORNE K. ROSENFIELD Reprinted with permission from Nahai F. The Art of Aesthetic Surgery: Principles and Techniques, 2nd edition. St. Louis: Quality Medical Publishing, 2010. Copyright © 2010 Quality Medical Publishing, Inc. All rights reserved. 32_N2e_Rosenfield_r5_bs_969-994.qxd:Volume1 9/28/10 4:10 PM Page 970 970 Part VI Eyelid Surgery he lower eyelid blepharoplasty embodies a classic surgical paradox worth re- Tvisiting: the more one performs a particular surgery, the more respect it may command. Whereas ignorance may be bliss, knowledge can be quite motivating. Any surgeon who has critically assessed his or her skin-muscle flap lower blepharoplasty results would heartily agree with this statement. When I examined my own results, I observed, not as infrequently as I would have liked, two particular stigmata of a less than perfect result at the lower eyelid. First, lasting mild scleral show was evident, often preceded by weeks of overly optimistic eyelid taping. This 55-year-old woman, shown preoperatively and 1 year after a tra- ditional skin-muscle lower blepharoplasty, exhibits this telltale postoperative sign of scleral show. Second, residual crêpey skin was identified, most often after treatment of prodigious fat herniation. This 48-year-old woman, shown preoperatively and 1 year after a traditional blepharoplasty, exhibits this “untreated” redundant skin. I was compelled by these discomfiting observations to seek an effective solution—a modified procedure that would at once ensure optimal correction of the eyelid de- formities and yet maintain normal eyelid posture.
    [Show full text]
  • Blepharoplasty
    Blepharoplasty Bobby Tajudeen Brow position • medial brow as having its medial origin at the level of a vertical line drawn to the nasal alar-facial junction • lateral extent of the brow should reach a point on a line drawn from the nasal alar-facial junction through the lateral canthus of the eye • brow should arch superiorly, well above the supraorbital rim, with the highest point lying at the lateral limbus • Less arched in men • midpupillary line and the inferior brow border should be approximately 2.5 cm. The distance from the superior border of the brow to the anterior hairline should be 5 cm Eyelid aesthetics • The highest point of the upper eyelid is at the medial limbus, and the lowest point of the lower eyelid is at the lateral limbus. • Sharp canthal angles should exist, especially at the lateral canthus. • The upper eyelid orbicularis muscle should be smooth and flat, and the upper eyelid crease should be crisp. The upper lid crease should lie between 8 and 12 mm from the lid margin in the Caucasian patient. • The upper lid margin should cover 1 to 2 mm of the superior limbus, and the lower lid margin should lie at the inferior limbus or 1 mm below the inferior limbus • The lower eyelid should closely appose the globe without any drooping of the lid away from the globe (ectropion) or in toward the globe (entropion) Lid laxity and excess • A pinch test helps determine the degree of excess lid skin that is present. The snap test helps determine the degree of lower lid laxity and is useful in preoperative planning Evaluation •
    [Show full text]
  • My Lipstick? It's in Here Somewhere
    C M Y K Nxxx,2012-01-05,E,003,Bs-4C,E1 THE NEW YORK TIMES, THURSDAY, JANUARY 5, 2012 N E3 Skin Deep Beauty My Lipstick? Spots It’s in Here Somewhere Face EYES WIDE OPEN A California plastic surgeon has combined blepharoplasty (eyelid surgery) and browpexy (brow lift) to create an “All-in-One Eye Lid and Brow” lift that he says is less invasive than many similar procedures. Eyes The new lift takes 30 minutes and requires two internal stitches and about five days of recuperation. The procedure costs approximate- ly $4,500 and is available at the practice of Tancredi F. D’Amore, in Corte Madera, Calif. (damoreplasticsurgery.com). TOUPEES ARE CHEAPER Dr. Rob- ert M. Bernstein, of the Bernstein Medical Center for Hair Restora- tion in Midtown Manhattan, has Lips become the first doctor on the East Coast to use a robot (below) PRACTICAL Walker mesh bags are sturdy enough to be thrown into the PHOTOGRAPHS BY TONY CENICOLA/THE NEW YORK TIMES to help with hair transplants, ac- wash and transparent enough to reveal what kind of makeup is inside. cording to the company that de- veloped the machine, Restoration Robotics. The Artas System for By HILARY HOWARD she said, she would also include a brightening wand Illinois and the creator of YouTube’s popular Beauty OR many of us, the New Year brings with it a like Clarins Instant Light Brush-On Perfector (it Broadcast, also thinks the eyelash curler, though un- frenzy of resolutions to streamline and or- adds brightness around dark circles or shadows), a wieldy, is a purse essential.
    [Show full text]
  • How to Avoid Training Scars by CHRISTOPHER BRENNAN
    Continuing Education Course How to Avoid Training Scars BY CHRISTOPHER BRENNAN TRAINING THE FIRE SERVICE FOR 136 YEARS To earn continuing education credits, you must successfully complete the course examination. The cost for this CE exam is $25.00. For group rates, call (973) 251-5055. AVOIDING TRAINING SCARS ● methodology was Donald Meichenbaum, who initially “fo- ally five or 10 push-ups. The initial time standards are very How to Avoid cused on cognitive-emotional theory of anxiety and learning generous, 90 seconds or so, to train the student to handle the approaches for the development of cognitive and relaxation stress. We could, of course, make the initial time standard 60 coping skills for anxiety reduction.”1 Survival skills instruc- seconds (which is the minimum passing time), but then there tors have used variations on SIT from the days of ancient would be a lot of push-ups done and a great increase in anxi- warrior cultures without having a specific label for it. ety. Once we warm the group up with a few 90-second drills Training Scars From the brutal rites of passage that are part of initiation (which generally everyone passes), we can then slowly work into elite military organizations through the burn tower evo- our way toward the 60-second mark. As the time standard lutions with recruit academy candidates to law enforcement gets closer to the neurological skill capacity of the students, defensive tactics courses, those who are expected to place their anxiety will increase (they don’t want to do push-ups). their bodies in harm’s way have attempted from time imme- We coach them to control their breathing and focus on their morial to develop a mental toughness in their students.
    [Show full text]