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The application of SGS replicates the stratum corneum's occlusion properties, normalizing hydration of the scar site to that of healthy skin, perhaps inhibiting the instruction sent to the Alpelisib price fibroblasts to produce excess collagen cells.13 Figure 1. Water loss under extreme, high, and normalized conditions. To see this illustration in color, the reader is referred to the web version of this article at www.liebertpub.com/wound. Mechanisms of action of SGS Although the mechanism of action of silicone-based products in scar management have not been completely determined, there are many mechanisms by which clinical studies have shown them to significantly impact the improvement of both hypertrophic and keloid scars. The logical mechanism of scar therapy treatments is to counteract the phylogenetic process by which scars are formed. It is hypothesized that wound healing has been optimized for speed as opposed to quality of healing under far less sanitary conditions to prevent infection.12 This speed optimization is now less of a necessity, with higher demand for aesthetically pleasing and fully-functioning skin becoming an ever increasing focus in the medical and consumer industries. The application of SGS addresses the physiological processes associated with this speed optimization by way of numerous reported mechanisms. SGS's ability to provide improved occlusion and hydration to the wound bed has been cited as its key physical mode of action in numerous studies. The physiological impact of improved occlusion and hydration on a developing scar is to provide the newly formed, underdeveloped stratum corneum aid in retaining optimum water levels. If the stratum corneum is dehydrated, it will signal to the keratinocytes in the epidermal skin layer to produce cytokines, which in turn signal fibroblasts to produce excessive amounts of collagen to aid water retention of the stratum corneum. It is by this process that the undesirable attributes of a hypertrophic scar are developed, rather than that of normal skin. Whereas it was once considered that higher occlusion is better, newer studies have shown that too strong a moisture barrier can have a detrimental effect,13 SGS is known to simulate the homeostasis of the stratum corneum.14,15 SGS, unlike other dressings, provide a level of occlusion similar to normal skin, which is thought to explain why cytokine and fibroblast activity and collagen formation are significantly reduced in SGS-treated scars16�C18 and stratum corneum hydration is normalized.19 It is worth noting that the gentle removal of SGS compared with alternative adhesive sheeting also minimizes skin stripping of the newly formed stratum corneum, further contributing to its treatment potential.20,21 Another physical mode of action provided by SGS is transferring tension from the lateral edges of the wound bed to the silicone gel sheet.