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The use of mechanical pressure by compression devices is recommended in the therapy for keloid scars. Pressure can theoretically break up collagen bundles and dissolve the keloid mass; however, therapy must be instituted for long periods (>23 h/d for 6 mo) before significant improvements can be achieved. Unfortunately, several regions of the head and neck are not susceptible to pressure application. Silicone sheeting is used to decrease the irritation and pruritus linked with keloids (commonly misspelled as kiloids). The proposed course of action involves the preservation of scar hydration and inducement of a subsequent decrease in cytokine liberation, resulting in reduced collagen accumulation. Some authors report important advancement in keloid minimization with this modality. Sadly enough, the global opinion on silicone sheeting doesn't support significant minimization in the dimensions or pigment characteristics of keloids, although silicone sheeting can be highly effective in decreasing pruritus.

Various therapies, including vitamin A, nitrogen mustard, tetroquinone, antihistamines, zinc, retinoic acids, vitamin E, and verapamil, have been used with variable degrees of success.

An article written by a group of scientists from Dipartimento di Scienze Chirurgiche Universita degli Studi di L'Aquila [Silicone occlusive sheeting vs silicone cushion for the treatment of keloid and hypertrophic scars. A prospective-randomized study] states the following:

BACKGROUND: Silicone gel and silicone compressive sheeting are widely used at present for the therapy of keloid and hypertrophic scarring. In recent studies the instance was raised that static electricity generated by friction stimulated silicone sheeting could be the explanation for this benefit, and that it could, with time, cause regression of hypertrophic and keloid scarring.

The objective of this research was to test this possibility and to discover weather a permanent and elevated negatively charged static electric field would reduce the treatment time. A silicone cushion was developed with the purpose of elevating a negative static-electric charge to abbreviate the regression process.

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

RESULTS: Therapy with the silicone cushions produced 74.2 percent cessation of itching and burning followed by pallor and flattening of the scar, some noticeably so. This was registered anywhere from a few 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 use of the cushion, resulting in a fairly rayed alleviation of these scars over a period of two months. Treatment with the silicone occlusive sheeting produced 52.3 percent itching and burning cessation followed by pallor and minimizing of the scar, some noticeably 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 observations of this trial using silicone cushions for the therapy of hypertrophic and keloid scarring with those observed using silicone gel or occlusive sheeting, a much faster response was shown. This action may be heightened when the treatment is followed with a natural skin care treatment that helps regenerate skin cells.