August 2023

Tape products for managing scars

Scar management is a specialist field, which embraces a number of invasive and non-invasive treatment options. This article focuses on products, which are available in tape or plaster form for the management of bulky scars, namely hypertrophic and keloid scars.

Rationale for the use of tapes

Tape and plaster products are popular for a number of reasons including:

• They are patient friendly i.e require minimal ongoing supervision from a qualified professional
• Their application is not painful, hence are considered non-invasive options
• Some are designed to release active ingredients, which help improve scar characteristics
• They can provide support to the scar; the nature of the carrier allows coverage of the scar as well as surrounding skin and hence reduces local tension. Furthermore, tapes can maintain moisture levels, which is known to down regulate the scarring process (O’Shaughnessy, 2009).

Some of the most commonly used tapes are presented below: 

a) Paper microporous tape

This product mimics the function of the outer layer of the skin (stratum corneum) and preserves a moist environment around the scar. It has significant advantages including ease of application, durability and low cost.

A randomised controlled trial in caesarean section scars showed that paper tape use commenced at the time of suture placement or removal and applied for 12 weeks improved the scar bulk significantly (Atkinson, 2005).  The authors recommended longer application periods for high risk patients until the scar reaches maturity. 

Similar results were reached in a study using adhesive strips for 12 weeks following surgery to the torso with results confirming improved scar appearance (Rosengren H et al, 2013).  Microporous tape applied in a particular manner to diminish tension around established scars, has also shown promising results in improving thickness/overall quality as well as symptoms of pain and itch (Daya M, 2011).

Most interestingly, an animal study has shown that paper tape is equally effective as silicone sheets in preventing hypertrophic scarring (Tollefson TT, 2012).

Patients can apply a strip of tape with minimal overlap to neighbouring skin and can shower over it.  Standard advice includes patting the area dry and replacing the strip if it separates off or becomes soiled.  The lifetime of each section of tape varies between a couple of days to weeks depending on how oily an individual’s skin is.  Most patients find that the carrier acts like a moisture trapping device, nevertheless, a moisturising agent can be applied over the surface as needed (Widgerow AD, 2000).

b) Silicone tapes

Silicone tapes/strips are very popular worldwide for both prevention and management of unfavourable scarring.  A number of studies involving traumatic/burn scars have indicated that silicone strips can improve symptoms like pain/itch and decrease scar thickness (Li-Tsang CWP, 2006) with superior results obtained if strips are used in combination with pressure garments (Li-Tsang CWP, 2010).  Similar effects have been described in limited number of studies involving keloidal scars with a short term effect on pain and itch (Eishi K, 2003).

 According to a robust review of all current reports, there is weak evidence that silicone gel sheeting has a role in preventing/ treating hypertrophic scarring since studies were found to be highly biased and of poor quality (O’Brien L, 2013).  More interestingly, a controlled trial has revealed that the efficacy of silicone and non silicone dressings for are equal in terms of colour and dimensions (de Oliveira, 2001); additionally, a comparative study of silicone sheets versus paper tape in postoperative caesarean section scars has failed to show clinically meaningful advantage of silicone in preventing bulk formation (Lin Y-S et al 2020).  My experience suggests that treating established hypertrophic and keloid scars with silicone sheets only yields temporary results for scar related concerns and patients are better off choosing more established modalities of scar management like laser treatment or steroid injections (Tan E et al, 1999).

Patients are advised to wear the silicone strip for a couple of hours initially and increase duration by 2 to 4 hours each day until they apply the device 24 hours a day.  It is important that the strip is washed with soap and water at least once a day and dried before it is re-applied to the scar.  It is considered best practice to have a trial of silicone strips for six months nevertheless if no improvement is noted after three months, it is advisable to consult with a qualified professional.

Scars should be moisturized regularly and the strip to be applied after the moisturizing agent is fully absorbed.

Embrace device.  This is a pressure relieving lattice made of silicone adhesive dressing.  It is applied over the centre of the freshly closed wound to offload tension and renewed every week for a period of 8-12 weeks.  A small trial has shown promising results with improved scar appearance at 6 months follow up (Lim, 2014).  Another larger trial involving tummy tuck operation patients for 5 up to 13 weeks of application showed significant improvement in scar appearance at 12 month follow up (Longaker MT et al, 2014).

c) Steroid tape

Steroid containing plasters are a patient friendly way of delivering active substance to improve scar bulk (i.e hypertrophic/keloid scars).  They are available on prescription in two different strengths in the UK; the medium strength fludroxycortide and higher strength deprodone proprionate.  Steroid tape can be used as first line treatment for small sized scars or as preventative therapy for high risk patients following surgery as well as steroid injection induction treatment (Goutos, 2017, Arima, 2019)).  The product is applied to the scar and a narrow margin of the surrounding skin and replaced every 24-48 hrs.  Aside the pharmacological action of the steroid component, the tape component helps maintain moisture in the tissues and provides scar support.

Steroid tape can also be used in combination with energy-based treatments; it has been successfully shown to decrease the treatment time of hypertrophic scars if used in combination with vascular Nd:YAG laser treatments (Tsai C-H, 2019).

In summary, there are various adjuncts in tape/plaster form, which can be useful in scar management. It is important to consult with a specialist (dermatologist or plastic surgeon) early on in your scar management journey to identify the most appropriate modality and ensure optimal long term scar quality. 

Ioannis Goutos, Consultant Plastic Surgeon
Specialist Interest in Scar Management

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References

O’Shaughnessy K, De La Garza m, Roy NK, Mustoe TA.  Homeostasis of the epidermal barrier layer: a theory of how occlusion reduces hypertrophic scarring.  Wound Rep Reg 17: 700-8 2009.

Atkinson JAM, McKenna KT, Barnett AG et al.  A randomized, contolled trial to determine the efficacy of paper tape in preventing hypertrophic scar formation in surgical incisions that traverse Langer’s skin tension lines.  PRS 2005, 116:1648-56.

Rosengren H, Askew DA, et al.  Does taping torso scars following dermatologic surgery improve scar appearance?  Dermatol Pract Concept 2013;3(2): 75-83.

Daya M.  Abnormal scar modulation with the use of micropore tape.  Eur J Plast Surg 2011 34:45-51.

Tollefson TT, Kamangar F, Aminpour S et al.  Comparison of effectiveness of silicone gel sheeting with microporous paper tape in the prevention of hypertrophic scarring in a rabbit model.  Arch Facial Plast Surg 2012; 14(1):45-51.

Widgerow AD, Chait LA, Stals R, Stals PJ.  New innovations in scar management.  Aesth Plast Surg 2000 24:227-34.

Li-Tsang CWP, Lau JCM, Choi J, Chan CCC, Jianan L. A prospective randomized clinical trial to investigate the effect of silicone gel sheeting (Cica-Care) on post-traumatic hypertrophic scar among the Chinese population. Burns. 2006 Sep;32(6):678–83.

Li-Tsang CWP, Zheng YP, Lau JCM.  A randomized clinical trial to study the effect of silicone gel dressing and pressure therapy on posttraumatic hypertrophic scars.  J Burn Care Res 2020;31;448-57.

Eishi K, Bae S, Ogawa F, Hamasaki Y, Shimizu K, Katayama I. Silicone gel sheets relieve pain and pruritus with clinical improvement of keloid: possible target of mast cells. Journal of Dermatological Treatment. 2003 Dec 12;14(4):248–52.

O'Brien L, Jones DJ. Silicone gel sheeting for preventing and treating hypertrophic and keloid scars. Cochrane Database of Systematic Reviews 2013, Issue 9. Art. No.: CD003826. DOI: 10.1002/14651858.CD003826.pub3.

De Oliveira GV, Nunes TA, Magna LA, Cintra ML, Kitten GT, Zarpellon S, Do Amaral CMR.  Silicone versus nonsilicone dressings: a controlled trail.  Dermatol Surg 2001;27;721-726.

Lin Y-S, Ting P-S, Hsu K-C.  Comparison of silicone sheets and paper tape for the management of postoperative scars: A randomized comparative study.  Adv skin wound care 2020;33:1-6. 

Tan E, Chua SH, Lim JTE.  Topical silicone gel sheet versus intralesional injections of triamcinolone acetonide in the treatment of keloids- a patient-controlled comparative clinical trial.  J Dermatol treatment 1999;10:251-54.

Lim AF, Weintraub J, Kaplan EN et al.  The embrace device significantly decreases scarring following scar revision surgery in a randomized controlled trial.  PRS 204; 133: 398-405.

Longaker MT, Rohrich RJ, Greenberg L et l.  A randomized controlled trial of the embrace advanced scar therapy device to reduce incisional scar formation.  PRS 2014 134: 536-46.

Goutos I, Ogawa R.  Steroid tape: a promising adjunct to scar management.  Scars, Burns & Healing, Volume 3, 2017; DOI:10.1177/2059513117690937.

Arima J, Dohi T, Kuribayashi S, akaishi S, Ogawa R.  Z-plasty and postoperative radiotherapy for anterior chest wall keloids: an analysis of 141 patients.  Plast Reconstr Surg Glob Open 2019;7e2177; doi: 10.1097/GOX.0000000000002177.

Tsai C-H, Kao H-K, Akaishi S et al.  Combination of 1,064-nm neodymium-doped Yttrium Aluminium garnet laser and steroid tape decreases the total treatment time of hypertrophic scars: An analysis of 40 cases of cesarean-section scars.  Dermatol Surg 2019.