Triterpenes for Well-Balanced Scar Formation in Superficial Wounds

Abstract

Triterpenes are demonstrably effective for accelerating re-epithelialisation of wounds and known to improve scar formation for superficial lesions. Among the variety of triterpenes, betuline is of particular medical interest. Topical betuline gel (TBG) received drug approval in 2016 from the European Commission as the first topical therapeutic agent with the proven clinical benefit of accelerating wound healing. Two self-conducted randomized intra-individual comparison clinical studies with a total of 220 patients involved in TBG treatment of skin graft surgical wounds have been screened for data concerning the aesthetic aspect of wound healing. Three months after surgery wound treatment with TBG resulted in about 30% of cases with more discreet scars, and standard of care in about 10%. Patients themselves appreciate the results of TBG after 3 months even more (about 50%) compared to standard of care (about 10%). One year after surgery, the superiority of TBG counts for about 25% in comparison with about 10%, and from the patients' point of view, for 25% compared to 4% under standard of care. In the majority of wound treatment cases, there is no difference visible between TBG treatment and standard of care after 1 year of scar formation. However, in comparison, TBG still offers a better chance for discreet scars and therefore happens to be superior in good care of wounds.

Keywords: acceleration of healing; aesthetic benefit; scar formation; topical betuline gel; triterpene; wound care.

Figure 1

Scar formation of laser skin lesions treated by TBG, hydrocolloid or gauze (one of 50 cases presented). The columns (Tag 1, 7, 14, 28, Woche 10) show the status of healing at days 1, 7, 14, 28 and after 10 weeks, beginning at the left side with day 1 after making 3 laser skin lesions of similar size and depth. The lines (Imlan Creme Pur, Comfeel Plus, unbehandelte Kontrolle) show the 3 different methods of treatment of the 3 similar laser skin lesions, being TBG at the top line, hydrocolloid in the middle, and gauze at the bottom line.

Figure 2

Skin graft wound, separated in two halves, treated with TBG at the upper half and standard of care at the lower half, left photo showing situation of healing 14 days postoperatively, middle photo showing situation of healing 3 months postoperatively, and right photo showing situation of healing 12 months postoperatively [27].

Figure 3

Four different skin graft wounds from four different patients, showing an intra-individual comparison of TBG-treatment (upper half) and standard of care (lower half) for four different results of scar formation [27].

Figure 4

Typical clinical aspect of fresh skin graft wound just before starting TBG-treatment (upper half of the surgical site (left side) and 12 months postoperatively as clinically mature scar (right side) [27].