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Management of surgical skin incisions has drawn a tremendous amount of research and studies to develop strategies, mainly topical applications, to improve the ultimate appearance of the scars.  Numerous topical agents are used today and there is considerable debate as what is the best scar therapy. Less frequently evaluated and, in the spirit of prevention is better than treatment, is pre treating or priming the skin before the incision is made. This is a novel approach to scar therapy and is somewhat akin to elevating one’s nutrition before surgery in the hope of a faster recovery.  

In the April 2021 issue of the journal Pharmaceutics an article was published on this topic entitled ‘Pre-Emptive Priming of Human Skin Improves Cutaneous scarring and is Superior to Immediate and Delayed Topical Anti-Scarring Treatment Post-Wounding: A Double Blind Randomized Placebo-Controlled Clinical Trial’. The objective of this study was to deliver an active compound prior to skin incisions to determine if it improves postoperative scarring compared to a postoperative scar therapy. The authors previously showed that topical epigallocatechin-3-gallate (EGCG) is effective at improving skin scarring when applied after surgery. A double blinded randomized placebo-controlled trial compared the effects of topical priming of the skin pre-surgery with an anti-scarring topical post-surgery in forty (40) volunteers. The volunteers were split into four groups, each undergoing different modes of application versus a placebo. In Group 1 the skin was primed 7 days before surgery, in Group 2 the skin was primed 3 days before surgery, in Group 3 the topical application was done on the day of the surgery and in  Group 4 the topical application was delayed until 14 days after surgery. Skin biopsies of the upper arm incisions were evaluated weekly out to 8 weeks with histological, immunohistochemical, mRNA sequencing and QRT-PCR studies. 

Their findings showed that EGG reduced mast cells at weeks 4 and 8 by gene and protein analyses (p < 0.01) Group 1 was superior to other groups (p < 0.01) in both clinical (blood flow) and laboratoryparameters (elastin and immune marker expression). Additionally, there was down-regulation of angiogenic-markers by mRNA-sequencing and of CD31 and VEGF-A at weeks-4 and 8 (p < 0.01) by immunohistochemistry and at week-4 (p < 0.05) by QRT-PCR. EGG increased antioxidant levels (HO-1) at week-4 (p < 0.01) plus elastin at week-8 (p < 0.01). 

Based on these results the paper concludes that pre-emptive priming of skin pre-injury with EGCG shows signs of significantly reduced skin scarring as evidenced by reducing mast cells, improving angiogenesis and blood flow as well as also increasing elastin content.

Epigallocatechin gallate (EGCG) is not new and is well known plant-based catechin compound, most commonly found in green tea. Its mechanism of action is anti-inflammatory and as an antioxidant to protect the cells from free radical damage. It also has been shown to have skin rejuvenation benefits by reducing wrinkles, improving moisture retention, and smoothing skin texture. It is widely used as an oral supplement but serum and liquids are also available.

This study is certainly a well conducted one and provides promise that the use of EGCG on aesthetic incisional locations before surgery may be helpful and certainly are not helpful. The ‘problem’ currently what would one use since no formal topical EGCG is currently available.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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