Scar Treatment Creams: Which to Choose, How Long to Use Them, and Which Scars Need More Than a Cream. A Dermatologist Explains Silicone Gel, Silicone Sheets and More
Topical scar treatment is a medicine or cosmeceutical applied to the skin after a wound has fully closed, to help a scar become flatter, softer and closer in colour to the surrounding skin. It is not a medicine that makes a scar disappear without a trace, because scar tissue is collagen that the body rebuilds in a disorganised pattern, and it cannot be turned back into normal skin by applying a cream alone.
When many people feel that a scar cream “doesn't work,” it is usually not because they picked the wrong brand. It is because of three things: using a treatment that does not match the type of scar, not using it for long enough, and expecting a topical product to do the job in cases that should have been treated with injections or procedures from the start. This article sets out clearly what each type of scar needs, how much evidence there is for each group of ingredients, how long they must be used, and when a topical product is not the answer.
What scar creams can and cannot really do
Scar creams really work in three ways: they add moisture and reduce the loss of water from the skin (transepidermal water loss), which signals the collagen-producing cells to slow down; they reduce chronic inflammation around the wound, which keeps driving the scar to rise higher; and they soften the upper layer of skin so the scar moves better with the surrounding skin.
What a cream cannot do is dissolve thick fibrous tissue, lift a sunken scar until it is level, or make a keloid that has already grown shrink back to the level of the original skin. These cases always need injections, laser or surgery as well.
The result of a topical product therefore depends mainly on timing. A scar remains in a phase where the body can still remodel collagen for roughly the first 12–18 months after the injury. This is when a topical product has the best chance of changing the outcome. After that the scar settles, and a cream can only help with moisture and softness.
Tell them apart before you buy: the word “scar” covers 5 different things
This is the point that most general web pages skip, recommending the same cream to everyone, even though these five types respond to completely different treatments.
Hypertrophic scar — raised, but does not extend beyond the edge of the original wound
Keloid — raised and spreading beyond the edge of the original wound
Atrophic scar — sunken below the surrounding skin, such as acne pits and chickenpox pits
Post-inflammatory erythema (PIE) — red, but the skin surface is still smooth
Post-inflammatory hyperpigmentation (PIH) — dark, but the skin surface is still smooth
The last two are not scars in the medical sense, because the structure of the skin is still normal. They are only a temporary colour change. Silicone therefore does not work on dark marks, and this is the most common reason behind the complaint “I applied scar cream and nothing changed.”
You can do a first check yourself with just two questions: does it catch your finger when you stroke it, and does the raised edge extend beyond the original wound? If it feels smooth and level with the skin, the problem is colour, not tissue.
Hypertrophic scar
Appearance: Raised, red or pink and firm, sitting exactly within the boundary of the original wound. It usually forms 4–8 weeks after the wound closes and tends to flatten on its own within 1–2 years.
Cause: A wound that is pulled and under high tension, such as over the shoulders, chest or joint creases, or a wound that was inflamed or infected for longer than usual.
Severity/urgency: Not dangerous, but the sooner you start care, the better the result. The golden window is the first 1–3 months after the wound closes.
When to see a doctor: When the scar keeps getting thicker beyond 3 months despite regular silicone use, or when itching and pain interfere with daily life.
Topical treatment used: Silicone gel or silicone sheets are the first approach, used continuously for at least 12 weeks. If there is no response, the next step is a steroid injection into the scar.
Keloid
Appearance: Firm, raised, dark red to purple, spreading beyond the edge of the original wound into normal skin. It does not shrink on its own over time and often itches or throbs.
Cause: Genetics and skin type play a large role. It is common in darker skin. Typical sites are the chest, shoulders, earlobes and jawline, often following inflamed acne, ear piercings or surgical wounds.
Severity/urgency: It is not cancer, but the longer it is left, the harder it is to treat, and simply cutting it out with no additional treatment has a very high chance of coming back.
When to see a doctor: As soon as you see the raised area starting to grow beyond the edge of the original wound. Do not wait for three months to pass.
Topical treatment used: Silicone can be used as an add-on and to help prevent recurrence, but almost no keloid clears with a topical product alone. The main approach is a steroid injection into the scar. For more detail on how it differs and how it is treated, read Keloid vs hypertrophic scar: what is the difference.
Atrophic scars and acne pits
Appearance: Sunken below the surrounding skin, divided into narrow, deep, puncture-like pits (ice pick), sharply edged flat-bottomed pits (boxcar), and wave-like pits with sloping edges (rolling).
Cause: Inflammation destroys collagen beneath the skin until it is depleted. They appear after deep inflamed acne nodules, chickenpox and infected wounds.
Severity/urgency: Not dangerous, but they do not go away on their own and do not go away with a topical product, because the lost tissue has to be rebuilt.
When to see a doctor: If you still have inflamed acne, get the acne under control first, because treating the pits while new inflammation continues is not worthwhile.
Topical treatment used: A topical retinoid can help with skin smoothness and stimulate some collagen in shallow pits, but deep pits need procedures. Read more in Acne pits: can they really be filled in.
Post-inflammatory erythema (PIE) — not a scar
Appearance: A flat red or pink mark, with skin that is smooth and level. The colour briefly fades when pressed. Seen most in fair to medium skin tones.
Cause: Small blood vessels remain dilated after inflammation. It is not pigment and not fibrous tissue.
Severity/urgency: It can fade on its own, but slowly, generally in 3–6 months and sometimes up to 1 year.
When to see a doctor: When it has not faded at all after 6 months, or it bothers your confidence enough that you want to speed things up.
Topical treatment used: Silicone does not help. What helps is sunscreen and avoiding repeated inflammation. If you want to speed up the result, a vascular laser is the option doctors use specifically for this kind of redness.
Post-inflammatory hyperpigmentation (PIH) — also not a scar
Appearance: A brown to grey-black mark with smooth skin, matching the boundary of the original lesion. Seen most in darker skin tones such as Thai skin.
Cause: Melanin pigment is left behind in the epidermis or dermis after inflammation. Sunlight makes it darker and keeps it longer.
Severity/urgency: Not dangerous, and it can fade on its own in 6–12 months if it is not exposed to sun again.
When to see a doctor: When the mark gets darker instead of fading, or spreads wider than its original location.
Topical treatment used: This calls for pigment-modifying agents, not scar treatments. Details are in the next section and in Post-inflammatory hyperpigmentation (PIH): causes and ingredients that really help.
Contracture scars — where a topical product is not the answer
Appearance: A wide sheet of scar that pulls on the surrounding skin, usually crossing a joint such as the neck, armpit, elbow, wrist or fingers.
Cause: Burns, scalds or large wounds that healed by contraction of the wound edges.
Severity/urgency: The most urgent of all scar types, because it restricts movement and can cause a joint to become permanently stiff. In children it can interfere with the growth of an arm or leg.
When to see a doctor: As soon as you find you can no longer fully straighten or bend the joint as before. Do not wait to try a cream.
Topical treatment used: Only as supportive care. The main approaches are physiotherapy, stretching splints, and corrective surgery by a surgeon.
Silicone — the only topical option that can be used as a first approach
Among all the ingredients sold under the name “scar cream,” silicone is the only group that international clinical guidelines rank as first-line for preventing and treating hypertrophic scars and keloids. The active material is medical-grade silicone / polysiloxane, which is not absorbed into the skin but works by forming a film over it.
The two best-explained mechanisms are these: the silicone film reduces water loss from the upper layer of skin, which signals the fibroblasts that the skin is fully sealed and lowers collagen production; and the film also reduces friction and repeated inflammation on the scar.
What silicone does not do: it does not fade dark marks, does not fill acne pits, and does not significantly change the shape of a scar that has been settled for more than 2 years.
Silicone gel vs silicone sheets: what is the difference, and how to use them so they work
This is a detail that product-selling pages rarely mention, even though it is one of the leading reasons people get no result: the length of time the silicone is in contact with the skin matters, not the amount applied.
Silicone gel: Apply a thin layer to cover the whole scar and let it dry into a film for about 4–5 minutes before putting on clothes. Use it twice a day. It suits the face, joint creases and areas where a sheet is hard to keep in place.
Silicone sheet: It must cover the scar and extend slightly past its edges. Use it at least 12 hours a day, and up to 24 hours if tolerated. Wash the sheet with clean water once a day and reuse it until it loses its stickiness.
Total duration: Both forms must be used continuously for at least 12 weeks, and a thick hypertrophic scar may need up to 6 months before the result can really be judged.
The most common mistake is using the gel once a day at bedtime and stopping at 3–4 weeks because “nothing seems to change,” which is three times sooner than the time the treatment actually needs.
Precautions: Do not use on an open wound, a wound that still has a scab, or a wound with signs of infection. Always wait until the skin has fully closed. If an itchy rash or macerated skin develops under the sheet, stop using it and consult a doctor.
Onion extract (Allium cepa) — what the evidence says
Onion extract is a popular ingredient in scar gels sold in pharmacies. The active ingredients cited are quercetin and other flavonoids, which have anti-inflammatory and collagen-suppressing effects at the laboratory level.
In real patients, the evidence is not as strong as for silicone. The existing studies are inconsistent: some found a slight benefit for redness and softness, while others found no significant difference from a control gel.
The practical conclusion is that onion extract is an acceptable add-on, not the main treatment. If you have to choose only one, choose silicone. And if a product contains both silicone and onion extract, the main benefit still comes from the silicone.
Heparinoid, vitamin E, and ingredients people expect too much from
Heparinoid: Has mild moisturising and anti-inflammatory effects and is often combined with onion extract. It is also considered an add-on.
Vitamin E (tocopherol): The best-known ingredient and the one with the weakest evidence. Controlled studies found it did not clearly improve scars, and some users developed contact allergy to the vitamin E itself.
Aloe vera and natural oils: They do moisturise, but there are no data showing they change the structure of a scar.
Ceramides and ordinary moisturisers: They clearly help keep the skin around the wound moisturised, which is a basic condition for a scar to soften, so they should be used alongside treatment, not instead of it.
Reading the label is therefore more important than reading the product name. Look for silicone or polysiloxane near the top of the ingredient list.
Creams for “dark marks” that people often buy by mistake as scar creams
If the skin feels smooth and the problem is darkening, the right group of products is completely different.
Hydroquinone 2–4% — The depigmenting agent with the most evidence. Apply to the spot once a day at bedtime and judge the result at 8–12 weeks. It should not be used continuously for longer than this without medical supervision, because of the risk of permanent darkening caused by the drug itself. In Thailand, concentrations above 2% must be prescribed by a doctor.
Azelaic acid 15–20% — A safer option for sensitive skin and pregnant women. Apply once or twice a day. It works more slowly, so judge the result at 3 months.
Topical retinoids (tretinoin 0.025–0.05%, adapalene 0.1%) — Speed up skin cell turnover and help disperse pigment. Start every other day to reduce irritation.
Topical vitamin C (L-ascorbic acid) and niacinamide 4–5% — Milder in effect, suited as add-ons and for long-term use.
The most important point for this group is that without sunscreen, every depigmenting product works much less well, because sunlight stimulates pigment production faster than the product can reduce it.
Topical retinoids for atrophic scars
For shallow pits and uneven skin after acne, a topical retinoid is the only topical group with a mechanistic rationale, because it stimulates collagen production in the dermis and speeds up skin cell turnover.
To reduce irritation, start at a low concentration and apply a pea-sized amount for the whole face 3 nights a week, then increase to every night within 4–6 weeks. Apply only on completely dry skin and follow with a moisturiser every time. Judge the real result at 12–24 weeks.
The limitation to state plainly is that a retinoid makes the skin around the pits smoother and softens the pit edges, but does not lift the base of the pit up to the level of the skin. Sharply edged pits and narrow deep pits still need procedures such as microneedling, fractional laser, or subcision.
Do not use during pregnancy or while planning a pregnancy.
Sunscreen — a measure that does more for scars than people think
New scars and post-inflammatory marks have less protective pigment than normal skin. Sun exposure in the first 6–12 months can therefore darken a mark permanently. In practice, sunscreen often does more for how a scar looks than an expensive scar cream applied inconsistently.
A practical approach is to use a sunscreen that protects against both UVA and UVB, SPF 30–50, reapplied every 2–3 hours when outdoors. For a scar already covered by a silicone sheet, apply sunscreen to the surrounding skin. For details on choosing one, read Sunscreen: how to choose the right one.
When to start, how long to apply, and how to tell whether it is working
When to start: When the wound is completely closed, with no scab and no oozing, which is generally 2–3 weeks after the injury or after the stitches come out. Starting before the wound has closed risks infection.
How long: At least 12 weeks for silicone, and 6 months for thick hypertrophic scars.
Signs it is working (check every 4 weeks): The redness fades, the raised height lessens when you stroke it against the neighbouring skin, itching and tightness ease, and the scar moves more with the surrounding skin.
Signs it is not working: After 12 weeks the height is the same or greater, the edges begin to spread beyond the original mark, or the itching and pain keep getting worse.
Take a photo in the same light and from the same angle every 4 weeks. This is a more accurate way to assess than going by feel, because scars change too slowly for the eye to notice by looking every day.
When a topical product is not enough — steroid injection into the scar
For hypertrophic scars that do not respond, and for almost all keloids, the main treatment is injecting a corticosteroid directly into the scar tissue (intralesional corticosteroid injection). The most commonly used drug is triamcinolone acetonide, at concentrations generally in the range of 10–40 milligrams per millilitre, adjusted to the thickness and location of the scar.
The usual pattern is to repeat the injection every 4–6 weeks, generally 3–5 times before the result can be judged clearly. The drug works by reducing inflammation and collagen production, so the scar becomes flatter and softer, and reduced itching is often the first thing patients notice.
Side effects to know before deciding include thinning or a dip in the skin at the injection site, localised lightening of skin colour, dilated small blood vessels, and pain during the injection. These side effects are why the dose, frequency and site must be decided by a doctor only, and are not something you can adjust yourself.
Other options doctors use when injection alone is not enough
5-fluorouracil (5-FU) A commonly used concentration is 50 milligrams per millilitre. It is often mixed with a steroid for keloids that resist treatment, to reduce the side effects of a high-dose steroid.
Pressure garments or devices (pressure therapy) apply continuous pressure for 12–24 hours a day for 6–12 months. This is a standard approach for scars from extensive burns and for earlobe keloids after surgery.
Vascular laser is used for scars that are predominantly red and for post-inflammatory erythema that will not fade.
Fractional laser and carbon dioxide laser are used to resurface the skin and stimulate new collagen in atrophic scars and scars with an uneven surface. They need to be done in cycles with spacing between sessions, and strict aftercare.
Surgical scar revision is used for contracture scars and large keloids, and must always be combined with adjuvant treatment after surgery, such as injections or pressure, otherwise the chance of recurrence is high.
The choice of method, the order of treatment, and the assessment of suitability must be made by a doctor after examining the actual scar, because two scars that look alike may need different plans depending on location, the age of the scar and skin type.
Scars after surgery and cosmetic surgery: how to care for them from day one
This is a very common question, and the answer differs from an ordinary wound in that the critical period begins even before you can start applying anything.
Wound still open (0–2 weeks): Follow the surgeon's instructions, keep the area clean, do not pick at scabs, and do not use silicone yet.
Starting topical treatment (2–3 weeks, after the stitches are out and the wound is fully closed): You can start silicone gel or silicone sheets, together with avoiding tension on the wound.
Watch phase (1–3 months): This is when hypertrophic scars tend to begin forming. If you see a clear increase in raised height in this period, see a doctor to consider an early injection rather than waiting.
Remodelling phase (3–18 months): Continue silicone and sunscreen, and review every 1–2 months.
Avoiding tension on the wound, such as not lifting heavy objects after an abdominal or chest wound as your doctor advises, affects the final shape of the scar no less than the product you apply.
Common misunderstandings about scar creams
“Apply it and the scar will disappear completely” — No topical product makes a scar disappear completely. The real goal is for it to be flatter, softer and blend better in colour.
“The thicker you apply it, the better” — An overly thick silicone film does not add any effect, but it can cause trapped moisture and irritation.
“A dark mark is a scar, so I need scar cream” — It is a different mechanism. It needs pigment-modifying products and sunscreen.
“Applying vitamin E will fade the scar” — The evidence does not support this, and some people develop an allergic rash.
“An old scar of many years can be cleared with a cream” — A scar that has settled for more than 2 years changes very little with a topical product. Consider procedures instead.
“It has to be expensive to work” — What determines the result is the type of scar, an ingredient that matches the mechanism, and how long it is used, not the price.
Signs that you should see a dermatologist and not keep applying products on your own
A raised scar that is growing beyond the edge of the original wound, which points to a keloid.
It keeps getting thicker after a full 3 months of correct silicone use.
Constant itching, pain or burning that disturbs your sleep.
A scar that crosses a joint and you can no longer fully straighten or bend it.
A scar with repeated open sores, bleeding or an abnormally raised edge, which must be distinguished from other kinds of lesions by a biopsy.
A scar on a child's face or joint should be assessed sooner than in an adult.
Quick summary
Tell them apart before you buy: Catches your finger when stroked = a true scar, needs silicone · Smooth but changed in colour = redness or dark marks, needs sunscreen and pigment-modifying products.
Silicone is the only first-line option with solid enough evidence. Gel twice a day; sheets at least 12 hours a day.
Duration matters more than brand. At least 12 weeks up to 6 months, starting once the wound has fully closed at around 2–3 weeks.
Onion extract, heparinoid and vitamin E are add-ons, not the main treatment, and vitamin E has the weakest evidence.
If after 3 months it is still rising or spreading beyond the edge of the wound, that is the point to move from a topical product to an injection by a doctor, not the point to change the brand of cream.
What to do today: Work out which of the 5 types above your scar belongs to, then choose the matching group of products. If it is a keloid or a contracture scar, book a dermatologist early instead of starting by trying creams.
For an overview of common skin conditions and how to care for them, read 30 common skin conditions, and for acne marks specifically, read Acne marks: what causes them.
Frequently asked questions about scar creams
Which scar cream is the best?
Medically there is no single “best” product for everyone, because what works depends on the type of scar. For hypertrophic scars or keloids, the one with the most evidence is medical-grade silicone, in both gel and sheet form. For dark marks, the one that matches the mechanism is hydroquinone 2–4% or azelaic acid 15–20% together with sunscreen. For acne pits, the topical with some rationale is a topical retinoid, though procedures are usually needed as well. What to look at on the label is the name and concentration of the active ingredient, not the product name.
Can the cream for raised scars be used for sunken scars too?
They cannot be used interchangeably, because the mechanisms are opposite. A raised scar comes from too much collagen, so the aim is to reduce collagen production, which is why silicone and steroid injections are used. A sunken scar comes from too little collagen, so the aim is to stimulate new production, which is why retinoids and collagen-stimulating procedures are used. Putting silicone on acne pits will not make them shallower, and putting a retinoid on a raised scar may cause irritation without any benefit. The easiest way to tell is to run a fingertip over it and feel whether it catches upward or dips downward.
When should I start applying scar cream after surgery?
You can start once the wound is completely closed, with no scab, no oozing, and the stitches properly removed, which for most people is about 2–3 weeks after surgery. Starting earlier on a wound that is not yet closed raises the risk of infection and slows healing. On the other hand, waiting longer than 3 months loses the period when treatment works best, because scars form most during the first 1–3 months. While you cannot yet apply anything, focus on keeping the area clean, not picking at scabs, and avoiding tension on the wound as your surgeon advises.
Can I buy scar cream at 7-Eleven?
Ordinary convenience stores are not a source of this group of products. Silicone products for scars and pigment-modifying products are sold at pharmacies with a pharmacist, medical supply shops, and clinics or hospitals. High-concentration hydroquinone and stronger retinoids must be prescribed by a doctor. The advantage of buying from a pharmacy with a pharmacist is that you can have them check the label and confirm that the ingredient you want is really near the top of the ingredient list, rather than included in a tiny amount for advertising purposes.
Why won't my scar go away even though I keep applying cream?
There are four most common reasons. First, using the wrong type, such as putting silicone on a dark mark, which is not a scar. Second, not using it long enough: silicone needs at least 12 weeks but most people stop at 3–4 weeks. Third, using it inconsistently or not keeping it in contact with the skin long enough, especially silicone sheets, which must be worn at least 12 hours a day. Fourth, the scar is a keloid or a thick hypertrophic scar that needed injections from the start. If you used the right type and it has still not improved after 3 months, see a dermatologist for an assessment instead of changing brands again and again.
Does cream still work on a scar that is years old?
It works much less, but not zero. A scar remains in a phase where the body can still remodel it for roughly the first 12–18 months, after which the tissue settles and responds less to topical products. In a scar older than 2 years, silicone can still help with softness, moisture and itching, but it usually does not clearly change the height or shape. In this case the approach that really delivers is an assessment by a doctor to consider injections, laser or corrective surgery according to the type of scar. Applying a cream continuously without reassessment often wastes several months with none of the desired result.
Warning: Treating scars with injections, laser or surgery carries a risk that the result will not be as expected, and may cause harm or side effects. Results vary from person to person. Treatment should always be assessed and performed by a doctor.
The information in this article is for educational purposes and is not individual treatment advice. The choice of product, concentration and duration of use must be decided by a doctor after examining the actual scar.
Written by Dr. Patara Voravutinon, Dermatologist · Last reviewed September 8, 2026
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