The use of mechanical pressure by compressive devices is advocated in the therapy for keloid scars. Pressure may theoretically separate collagen bundles and soften the keloid mass; however, treatment must be followed for long periods (>23 h/d for 6 mo) before substantial improvements can be achieved. Sadly, several regions of the head and neck are not amenable to pressure treatment. Silicone sheeting is used to minimize the distress and pruritus linked with keloids (commonly misspelled as kyloids). The proposed mechanism of action involves the maintenance of scar hydration and inducement of a subsequent decrease in cytokine release, resulting in reduced collagen accumulation. Some authors report great success in keloid minimization with this modality. Sadly enough, the general opinion on silicone sheeting doesn't support important reduction in the dimensions or pigment characteristics of keloids, although silicone sheeting can be highly effective in decreasing pruritus.

Several treatments, including antihistamines, vitamin A, zinc, nitrogen mustard, retinoic acids, tetroquinone, vitamin E, and verapamil, have been used with varying degrees of success.

Silicone occulsive sheeting vs silicone cushion for the treatment of hypertrophic and keloid scars. A prospective-randomized study is an article written by a group of Italian scientists that states the following:

BACKGROUND: Silicone gel and silicone compressive sheeting are widely used at present for the treatment of keloid and hypertrophic scars. In recent studies the possibility was raised that static electricity generated by friction activated silicone sheeting could be the explanation for this effect, and that in time it could cause regression of hypertrophic and keloid scars.

The objective of this study was to test this hypothesis and to observe weather a continuous and elevated negatively charged static electric field would reduce the treatment time. A silicone cushion was created with the purpose of elevating a negative static-electric charge to accelerate the regression process.

METHODS: From November 2001 to June 2002 we studied in a prospective randomized study, 72 individuals with hypertrophic and keloid scars. The trial extended over an 8-month period. Thirty-seven individuals used silicone occlusive sheeting, the remaining 35 patients used silicone cushion (Clinicel).

RESULTS: Treatment with the silicone cushions produced 74.2 percent cessation of itching and burning followed by pallor and flattening of the scar, some markedly so. This was registered anywhere from a couple of weeks to a five month time period. Additional 25.7 percent had their scars resolved in up to 8 months of treatment. Four patients (11.4 percent) who had recalcitrant scars with little response to the use of the silicone cushion were treated with intralesional corticosteroid injections, along with the application of the cushion, resulting in a fairly rayed resolution of these scars over a period of 2 months. Treatment with the silicone occlusive sheeting produced 52.3 percent itching and burning cessation followed by pallor and flattening of the scar, some markedly so, over a few weeks to five months period. Additional 22.1 percent had their scars resolved in up to 8 months of treatment.

By comparing the results of this test using silicone cushions for the treatment of hypertrophic and keloid scars with those observed with silicone gel or occlusive sheeting, a much faster response was shown. This course may be heightened when the treatment is accompanied by a natural skin care treatment that helps regenerate skin cells.