Is there really just one best scar treatment? With so many scar treatment options available it's often difficult to decide which one is best for you. Unfortunately most promise great results but then fail to deliver meaningful results. This article summarizes what works and what doesn't based on the clinical and scientific studies available.

Common scar treatment ingredients include:

SILICONE SHEETING & SILICONE GEL: Silicone improves the appearance of both old and new scars. Silicone sheeting is cumbersome to use and can interfere with make-up and clothing. Silicone gel (Dimethicone) is as effective as silicone sheeting and is much easier to apply. Easy make-up and sun-block application is an added benefit of the gel. Always check the ingredients to make sure the silicone is Dimethicone (certified as safe) and not potentially harmful silicones like D4 or D5 (eg Cyclomethicone, Cyclotetrasiloxane, Cyclohexasiloxane, Cyclopentasiloxane). These D4/D5 silicones are also volatile, meaning that they evaporate quickly after application on the skin. Because of this, the silicone benefit is very short-lived. Dimethicone silicone is not volatile and therefore stays on the skin much longer.

VITAMIN C: One of the skin's main components is collagen. Scars heal through new collagen formation. Untreated skin produces unorganized, haphazard collagen. Vitamin C helps to improve and organize collagen formation. Improved collagen formation leads to faster and more cosmetic scar healing. Vitamin C also decreases inflammation and is often used to lighten dark scars and brown spots. The main problem with vitamin C is its stability. Most formulations contain unstable vitamin C which oxidizes on exposure to air. This is associated with a change in the color, typically a dark yellow or brown. While applying oxidized vitamin C is not harmful, it is no longer useful as the effectiveness of the treatment is lost completely. Avoid vitamin C creams that are brown to begin with as this is typically done to camouflage oxidation.

VITAMIN E: Topical vitamin E (tocopherol) may be good for preventing sun-induced skin damage but it has NO effect on, and actually may WORSEN the appearance of scars in up to 90% of adults. Up to 33% of users develop a contact dermatitis to vitamin E (redness, itching and flaking). American dermatologists and Canadian pediatricians recommend completely avoiding scar creams containing vitamin E.

TOPICAL STEROIDS: Most people know that steroids decrease inflammation. However, independent studies have shown that topical steroids have no effect in reducing scar thickness or improving the cosmetic appearance of scars.

ONION EXTRACT: Several scientific studies in humans and animals have focused on onion extract, one of the main ingredients in Mederma skin care products. All showed NO benefit from topical use. Mederma performed no better than plain petroleum gel (or Vaseline) for scar redness, itchiness, pain, burning, thickness and overall scar appearance.

BOTANICALS: Many skin care products include natural plant extracts (botanicals) as ingredients, mainly because of their anti-inflammatory effects. Examples include onion extract (see above), licorice, curcumin, aloe vera, green tea, ginko, ginseng, soy, tea tree oil, arnica, bromelain, sunflower oil, safflower oil and chamomile. Of these, only a few have been shown to improve scar healing and appearance:

Licorice Extract:

• strong anti-inflammatory, accelerates skin renewal

• lightens dark scars and brown spots including melasma (especially when combined with a stable form of vitamin C)

• anti-acne effects (both prevention and treatment)

Aloe Vera:

• accelerates wound healing

• decreases inflammation

• stimulates new skin growth through amino acids

• promotes healthy healing in the deepest skin layers

Linoleic Acid (Safflower Seed Oil) and Oleic Acid (Sunflower Seed Oil):

• regenerate lipid biolayer crucial for skin moisture

• improve wound healing

• improve scar elasticity

• control production of prostaglandins, one of the skin's main "building blocks"

• prevent disturbance in prostaglandin production which causes poor healing

• lighten dark pigment (hyper-pigmentation)

Surprisingly, most scar treatments contain volatile D4 or D5 silicones, vitamin E, steroids, onion extract, or combinations of these ingredients. All of these either do not improve scar appearance or texture, or even worse cause contact dermatitis. Of all the scar treatments frequently recommended, only stable forms of vitamin C, dimethicone silicone and a handful of botanicals have been shown scientifically to help fade scars.