Compounding for Scarring and Keloids

Custom dermatological compounds that are efficacious and economical.

Safe + Effective Compounding for Scarring and Keloids

Safe + Effective Compounding for Scarring and Keloids

Compounding allows you to meticulously personalize treatment solutions for your patients. From choosing the appropriate base, creating an all-in-one product, or removing allergens or toxic additives, we can provide a solution, even when all else has failed.

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A scar is a thickened or discolored growth of tissue formed where the skin has healed after an injury. With the correct wound care, scarring can be minimized or prevented. New scars are typically pink-reddish in color, while older scars often turn lighter or darker than the surrounding skin.

  • Flat scars (cicatrix): Flat scars are often pink-reddish in color and slightly raised. They may itch or cause pain. As the scar heals, it flattens and changes color and may eventually blend in with the surrounding skin.

  • Raised scars (hypertrophic scar): Raised scars typically form on the chest, upper back, or shoulder area. They may itch or cause pain, and depending on where they form (e.g., shoulder, elbow, or other mobile zones), they may restrict movement.

  • Depressed scars (atrophic scar): Depressed scars sit below the surface of the skin. They are commonly caused by acne or chickenpox following damage to the collagen due to inflammation. These are more common on the face and may become more apparent with age.

  • Keloids: Keloids are raised scars that result from fibrous tissue outgrowths due to abnormal healing. The scar overgrows the boundaries of the original scar, hence is often bigger than the original wound. It may form months after the initial injury. Keloids never go away without treatment.

  • Contracture scars: Contracture scars are a class of scar that limits movement. These especially cause issues in mobile areas of the body. Moderate to severe burns typically cause contracture scars. Good wound care can help prevent contracture scarring.

  • Stretch marks (striae): Stretch marks are a class of scar resulting from breaks in the connective tissue. These arise as the skin grows or shrinks quickly (e.g., during adolescent growth, pregnancy, or due to rapid loss or gain of weight). Stretch marks often present as red, purple, or dark brown, but as they mature, they may change to white or silver. They may be slightly raised or lowered compared to the surrounding skin.

Scarring arises when there is an imbalance between the production and breakdown of collagen. The pathogenesis of wound healing depends on many internal and external factors.

Iternal factors include:

  • Hormonal growth factors (transforming growth factor (TGF), platelet-derived growth factor (PDGF))
  • Cellular matrix turnover rate
  • Genetic predisposition
  • Vitamin status
  • Immune status
  • Comorbidities such as diabetes mellitus

External factors include:

  • Wound size and depth
  • Wound stability/instability
  • Wound tension
  • Position/contraction
  • Incidence of infection

Treating scars requires management of the patient’s expectations and educating the patient thoroughly around the potential for recurrence or treatment failure. Most scars fade over time. However, some scars, such as keloids and sunken scars, don’t.

Treatment may:

  • Reduce the visible appearance of the scar or keloid

  • Alleviate pain and itch

  • Reduce constriction of movement

  • Pressure therapy: Wound pressure may reduce or prevent a scar. Pressure may be applied to the healing wound via an elastic bandage or stocking.

  • Massage: Clinical research promotes local mechanical stimulation to improve outcomes in the formation of the scar. Patient education is important, as the treatment must be adapted to the age and type of the scar.

  • Silicone gel (sheet or ointment): Silicone gel assists in reducing wound size, hardness, and redness as well as addressing swelling, itching, or constriction. It is often used post-surgery to prevent a raised scar from developing.

  • Polyurethane dressing: A flexible pad is used to reduce post-surgical scarring. It is typically combined with a pressure garment.

  • Laser and light treatments: Radiation treatment with light can prevent the formation of raised scars and keloids and reduce their appearance. Laser or light treatments are used in combination with corticosteroid injections. Laser treatment is also effective in:

    • Mitigating the pain, itch, hardness, and swelling often associated with a scar

    • Decreasing post-surgery scarring

    • Treating some classes of depressed acne scars

    • Lessening the redness of a scar

    • Reducing constrictions

  • Corticosteroid injections: A corticosteroid injected directly into the scar may reduce its size and mitigate the itch and pain. Multiple treatments may result in a reduction in scar size of 50% or more, and some patients experience full resolution. However, side effects include a return of the scar, localized thinning of the skin, and dark spots at the site of injection. A 5-FU injection or pulsed-dye laser therapy reduces the likelihood of such outcomes.

  • 5-FU injections: Injected directly into a scar, it can reduce or completely flatten a scar and ease itch and pain. Treatment requires 50 mg/ml, providing a total dosage of up to 50 to 150 mg per session and a maximum of 16 injections once per week for up to 16 weeks.

  • Microneedling: By inserting tiny needles into the skin surrounding the scar, the body may be stimulated to make more collagen. Microneedling may reduce the appearance of atrophic/depressed scars.

  • Cryosurgery: Cryosurgery is effective in reducing the size of a scar and reducing symptoms such as pain, itch, hardness, and discoloration. One treatment may reduce the size of a scar by 50% or more. Cryosurgery may be used in conjunction with a corticosteroid or 5-FU injection.

  • Scar surgery: A dermatologic surgery to reduce the size of a keloid is usually only an option if other treatments have failed. Recurrence of the scar can occur, and leaving the border of the keloid reduces this risk. Surgery is often paired with corticosteroid injections.

  • Radiation therapy: With an associated risk of cancer, radiation therapy reduces raised scars and keloids, relieves itch and discomfort, and reduces the risk of recurring scarring following surgery. Additional side effects include redness, swelling, dark spots, and itch.

  • Vitamin E cream

Patients can prevent scars from developing by keeping skin moisturized and hydrated. Although certain ingredients can make a difference, anything that creates a protective barrier on the skin’s surface and locks in moisture will protect the skin while it heals and improve the appearance of a scar.

There are numerous topical agents available for scar treatment, many of which are available over-the-counter.

Common ingredients include:

  • Vitamin E: Oils and creams containing vitamin E are the most popular for improving the appearance of scars. However, some studies suggest that adverse effects from vitamin E can actually slow wound healing and worsen the look of a scar.
  • Silicone: Silicone gels work particularly well to improve the appearance and bulk of scars, especially for burn patients. Patients must apply silicone gel 2–4 times per day, or as the scar dries. Although relief may be immediate, results are typically seen after at least two weeks of treatment and up to two months.
    • Pracasil ® silicone gel offers great efficacy, as it provides a barrier and also offers anti-inflammatory, antioxidant, bactericidal and fungicidal properties when combined with plant-derived Pracaxi oil. It is also a source of behenic acid which integrates well with the skin’s natural oils.
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  • Onion extract: Onion extract in a topical gel (such as Mederma) may improve scar appearance and texture. Onion extract has anti-inflammatory and bactericidal properties and acts against fibroblast-proliferation.
  • Honey: Applying honey to a healing wound or existing scar may speed the healing process and improve the scar’s appearance.
  • Salicylic acid: Salicylic acid can help to fade an existing mature scar by exfoliating dead skin cells and speeding up cell turnover. Be sure to layer with a moisturizing cream to protect the skin as it heals.
  • Retinol: Like salicylic acid, retinol works as an exfoliant to remove the top layer of skin as well as any dead skin cells.
  • Glycolic acid: For darker scars, a peel with glycolic acid works well to remove dead cells.
Type of Scar Treatment Options & Compounded Formulas
Immature Scars

Prevention is the best approach to scar treatment. Options include:

  • Pracasil ® silicone gel

  • Pressure dressing

  • Laser treatment (e.g. pulsed-dye laser)

Stretch Marks

Topical treatment with:

  • Hyaluronic acid topical serum

  • Tretinoin lotion

  • Pracasil ® silicone gel

Acne Scars

Compounded topical treatments with:

  • Salicylic acid

  • Retinoid cream

  • Alpha hydroxy acids

  • Lactic acid

  • Pracasil ® silicone gel

  • Chemical peels with trichloroacetic acid (TCA)

Atrophic Acne Scars

Microneedling

Raised Acne Scars

Identify as hypertrophic or keloid, and follow appropriate treatment algorithm.

Hypertrophic Scars
  • Corticosteroid injections

  • Laser therapy

  • Cryotherapy

  • Surgery

Small and/or Single Keloid

Topical treatment with Pracasil ® silicone gel

Consider surgery with combination therapy, including:

  • Laser therapy

  • Corticosteroid injection

Non-surgery monotherapy:

  • Corticosteroid injections

  • Cryotherapy

  • Laser therapy

  • 5-Fluorouracil

Large and/or Multiple Keloids

Consider a multi-modal approach.

Non-surgical monotherapy

  • Pracasil ® silicone gel

  • Corticosteroid injections

  • Cryotherapy

  • Laser therapy

  • 5-Fluorouracil

It should be followed up with long-term treatment, including:

  • Silicone gel (sheet/ointment) such as Pracasil ® silicone gel

  • Pressure therapy

  • Surgery with combination therapy (as last resort)

    • Laser therapy

    • Corticosteroid injection

Severe/Unresponsive Scarring

Consider intralesional triamcinolone injections.

Constricting Scars

Consider Botulinum Toxin A.

VLS Pharmacy | New Drug Loft can assist with compounding customized scar treatment therapies to meet your patient’s needs. By selecting a highly effective carrier, such as Pracasil®, we are able to create unique combination therapies tailored to the individual scar and patient’s skin type and responsiveness.

Effective treatment of scars requires a willingness to tailor the approach to the patient’s unique circumstances. Our team is ready to customize concentrations of treatment therapies to ensure efficacy.

PracaSil-Plus is a unique topical anhydrous silicone gel that can be used alone or with various actives for potential use in formulations. The only compounding base designed for scars and other skin conditions, PracaSil-Plus is an ideal choice for new scars, old scars, surgical scars, keloids, stretch marks (from pregnancy or growth), acne scars and any skin conditions that would benefit from barrier protection.

PracaSil-Plus contains unique ingredients with anti-inflammatory, antioxidant, antibacterial, and antifungal properties, Pracaxil oil is used for a variety of dermatological conditions, including skin spots, severe acne (and scars), psoriasis, and rosacea.

Ideal for:

  • Surgery centers

  • Orthopedics

  • Bariatric surgery centers

  • Weight loss clinics

  • OB/GYN

Please note: information on this site is not intended as medical advice and the medications listed are not specific to any individual. The content is intended to inform as to what may be possible. Listed medications and/or compounded formulas are not necessarily those compounded at VLS Pharmacy & New Drug Loft . Please speak with your prescribing clinician about your specific needs.

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LICENSES, AFFILIATIONS & ACCREDITATIONS

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As a 503A pharmacy, VLS Pharmacy* is committed to providing high-quality formulations of sterile and non-sterile compounded medications to you and your patients. Thanks to rigorous testing measures, we guarantee the safety, stability, purity, sterility, and quality of each formulation from preparation to administration. We use high-quality, active pharmaceutical ingredients sourced directly from PCCA, the leader of superior-quality APIs. Additionally, our pharmacy network meets USP <795> non-sterile standards and USP <797> sterile compounding guidelines. We’re also proud to host one of the first pharmaceutical labs built to USP <800> standards for handling hazardous drugs.

All of our medications undergo third-party potency and stability testing, and we complete high-sensitivity rapid endotoxin detection on-site. These measures allow for shorter delivery times to the patient without compromising our product quality. Because we source all of our active ingredients from PCCA, we also promise an additional level of pre-formulation testing, as PCCA ingredients undergo 14 high-level checks and reviews in order to pass inspection.

*New Drug Loft is also a 503A compounding pharmacy but specializes in strictly non-sterile compounding and therefore abides by USP <795> only.

For almost three decades, our team has been committed to serving our network of physicians and patients. We appreciate the opportunity to share our expertise as we develop advanced compounded formulations for those who need and want more than what is commercially available. We work hard to achieve excellence in all areas of our business -- from investment and advancement to personalized customer service and rigorous in-house and third-party safety testing and quality assurance. We are proud to prove the best, individualized medical solutions, compounded as needed.

Our 503A pharmacy network specializes in providing custom-made sterile and non-sterile compounded medications to physicians and patients across the country. Each prescription is crafted and delivered with a commitment to the highest level of quality, safety and service.

For more information about VLS Pharmacy, click here.