Silicone gel and sheets for scar management: how they are used

A scar is the mark left on the skin after a wound has healed. The NHS says you cannot get rid of a scar, but most will fade over time, and that this can take up to 2 years or more. Treatments are therefore aimed at improving how a scar looks and feels rather than removing it.

Silicone products for scars come as thin sheets, strips, gels and sprays. Chelsea and Westminster Hospital NHS Foundation Trust describes a silicone gel sheet as a soft, flexible, self-adhesive dressing that is applied over scars, and says silicone can help to improve the colour, height and texture of a scar and can relieve itching and discomfort caused by a scar.

The NHS includes silicone dressings or gels in its list of treatments that may be used for scars, with steroid injections or cream, cryotherapy, laser therapy and skin camouflage. For keloid scars, it lists steroid injections or cream, silicone dressings or gels, cryotherapy and laser therapy, and says surgery to remove a keloid scar is not usually recommended because it is likely to grow back bigger.

These products are used most often in hospital burns and plastic surgery therapy services and in community scar care, as well as being bought over the counter. The NHS says a pharmacist can recommend silicone dressings or gels, and creams to massage the scar.

The honest answer is that the mechanism is not fully known. Chelsea and Westminster says it is not clear exactly how silicone works on a scar, and that some research suggests the silicone creates a protective barrier over the scar which allows it to mature while helping to prevent the production of excess scar tissue. It adds that the silicone layer also assists with hydration of the scar.

That leaves room for individual differences. Some scars respond more than others, and the NHS describes different types of scars with different behaviours, which affect what can be expected. The NHS table of scar types describes keloid scars as raised, hard and smooth, growing bigger than the original wound and not usually flattening or fading without treatment, and hypertrophic scars as raised and firm but not growing bigger than the original wound and usually fading and flattening over time.

Your therapist, nurse or pharmacist will advise on the product and the schedule, and that advice takes priority over any general description. The Chelsea and Westminster leaflet gives a typical approach for a gel sheet.

• Make sure the affected area is clean and dry, and wipe off any excess cream if you have been massaging with cream.

• Remove the protective backing and place the sticky side on the skin.

• Build up skin tolerance: wear the sheet for 4 hours daily for two days, then increase gradually up to the amount of time your therapist advises.

• Wash the sheet daily with lukewarm soapy water, rinse well and pat dry with a non-fluffy towel.

• Wear the same piece until it starts to deteriorate, then replace it with a new piece.

The leaflet says not to use the gel sheet on open wounds, and that if you develop a wound in your scar you should remove the gel sheet and keep it safe until the wound has healed. It also says to remember to wash the sheet, because a build-up of dirt or bacteria may irritate the scar.

If you develop any irritation or redness in response to using it, the leaflet advises not to throw the sheet away: remove the sheet, wash and dry your skin, leave the sheet off until the symptoms settle, then try again, building up skin tolerance slowly.

The NHS advises asking for an urgent GP appointment or getting help from NHS 111 if a scar is swollen or painful, feels warm to the touch or has pus coming out of it, as these may be signs of infection. See a GP if a scar is painful or bothering you, because they may be able to recommend treatments.

The leaflet says 90 days is the recommended initial treatment period, and that you may be advised to continue for longer depending on the appearance and age of the scar. That is a practical guide: scars take a long time to mature. The NHS says scars may take up to 2 years or more to fade, and the Chelsea and Westminster skin graft leaflet gives a similar maturation time.

The same leaflet describes how supply works in that service: the therapist assesses which brand is most suitable and gives a small sample, and the GP is asked to provide an ongoing supply using a letter. If a GP or pharmacy cannot order the sheets, the leaflet says to tell the therapist, and that you can buy them yourself online. Arrangements differ between areas, so ask your own team or pharmacist.

The NHS suggests several things that can help most scars heal and improve how they look. It says to massage your scar with a water-based cream such as aqueous cream or E45 cream a few times a day for up to 10 minutes each time, only if the wound is fully healed, to keep the scar covered in the sun for at least 1 year, and to use sunscreen with an SPF of 30 or more on it.

Skin camouflage creams and powders can also be used to cover a scar so it is less noticeable. The NHS says a GP can refer you for an appointment or you can refer yourself online, and that the products can be obtained on prescription or bought.

The NHS notes that a GP can refer you for talking therapy if a scar is affecting your mental health. Scars can be itchy, painful or uncomfortable, and being bothered by one is a good reason to seek advice.

If a scar is over a joint or tight enough to limit movement, mention it to your GP or therapist early, because the NHS describes contracture scars as feeling tight and being difficult or painful to move, usually after a burn.

Silicone is not a cure and results vary. The leaflet describes benefits as improving colour, height and texture and relieving itch, not removing the scar. The NHS says you cannot get rid of a scar, but treatment can help improve how it looks.

For raised scars after burns, surgery or injury, silicone is commonly used by specialist therapists as part of a wider programme that may include massage, pressure garments and sun protection. Whether it is right for you depends on the type, age and site of the scar, which a clinician or therapist can assess.