Background and Objectives: Good scar management in burn care is essential. Nevertheless, there are no consistent recommendations regarding moisturizers for scar management. Our aim was to investigate and compare the effects of commonly used products on normal skin and burn scars. Materials and Methods: A total of 30 skin-healthy (control group) and 12 patients with burn scars were included in this study. For an intraindividual comparison, each participant received creams consisting of dexpanthenol (P), aloe vera (A), and a natural plant oil (O) with instructions to apply them daily to a previously defined area for at least 28 days. Objective scar evaluation was performed with Visioscan®; Tewameter®; Cutometer®, and the Oxygen To See® device. Subjective evaluation was performed with an “application” questionnaire, the Patient and Observer Scar Assessment Scale (POSAS), and with the “best of three” questionnaire. Results: After (A) a high trend of amelioration of +30%, TEWL was detected on the scar area. Blood flow increased slightly on healthy skin areas after (A) application to +104%. The application of (A) on healthy skin demonstrated a positive effect on the parameters of scaliness (+22%, p < 0.001), softness (+14%, p = 0.046), roughness R1 (+16%, p < 0.001) and R2 (+17%, p = 0.000), volume (+22%, p < 0.001), and surface area (+7%, p < 0.001) within the control group. After (P), a significant improvement of the baseline firmness parameter of +14.7% was detected (p = 0.007). (P) also showed a beneficial effect on the parameters of R1 (+7%, p = 0.003), R2 (+6%, p = 0.001), and volume (+17%, p = 0.001). (O) lead to a statistically significant improvement of volume (+15%, p = 0.009). Overall, most study participants stated (A) to be the “best of three”. Conclusions: (A) performed statistically best, and is a well-tolerated moisturizing product. However, further quantitative studies are needed to provide statistically significant clarification for uniform r A Subjective and Objective Skin and Scar Evaluation after Topical Treatment with Dexpanthenol, Aloe Vera, and Plant Oil Bagheri Mahsa Validation, Formal analysis, Writing – original draft, Visualization 1 Werres Michelle Formal analysis, Investigation, Data curation, Writing – review & editing 1 Fuchs Paul C 1 Seyhan Harun Validation, Writing – review & editing 1 Lefering Rolf Methodology, Formal analysis, Writing – review & editing 2 Grieb Gerrit 3 4 Schiefer Jennifer Lynn Conceptualization, Methodology, Validation, Investigation, Writing – review & editing, Supervision, Project administration 1 * Borgia Francesco Academic Editor 1 Clinic for Plastic and Hand Surgery, Burn Care Center, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), 51109 Cologne, Germany 2 Institute for Research in Operative Medicine (IFOM), Faculty of Health, Witten/Herdecke University, 51109 Cologne, Germany 3 Department of Plastic and Hand Surgery, Burn Center, Medical Faculty, RWTH Aachen University, 52062 Aachen, Germany 4 Department of Plastic and Hand Surgery, Hospital Havelhohe, 14089 Berlin, Germany * Correspondence: schiefer.jennifer@gmail.com 21 10 2023 59 10 1874 1874 28 10 2023 © 2023 by the authors. For an intraindividual comparison, each participant received creams consisting of dexpanthenol (P), aloe vera (A), and a natural plant oil (O) with instructions to apply them daily to a previously defined area for at least 28 days. Objective scar evaluation was performed with Visioscan ® ; Tewameter ® ; Cutometer ® , and the Oxygen To See ® device. Subjective evaluation was performed with an “application” questionnaire, the Patient and Observer Scar Assessment Scale (POSAS), and with the “best of three” questionnaire. Results: After (A) a high trend of amelioration of +30%, TEWL was detected on the scar area. Blood flow increased slightly on healthy skin areas after (A) application to +104%. Currently, there are no specific recommendations regarding moisturizers for scar management after burn injuries. Available recommendations are mostly based on the clinical experience of burn specialists, such as medical staff and employees. Very few are based on scientific evidence [ 1 ]. Creams commonly used in the Aloe vera as the leading ingredient is widely used in natural medicine as a healing agent. Some studies have already shown that aloe vera gels have positive effects, especially in wound therapy [ 9 , 10 , 11 ]. Panthenol-ratiopharm ® is used as a standard of care in our clinic in the aftercare of burn scars. This is also an occlusive ointment that is supposed to keep transepidermal water loss low. The active ingredient is dexpanthenol being converted to panthotenic acid, a coenzyme constituent which is well-known to have beneficial effects on wound healing and speed up the wound-healing process [ 12 , 13 ]. Theresienöl ® (Theresienöl GmbH, Kufstein, Austria), an oil originating from Austria, consists of purely plant-based ingredients such as apple and lily extracts, as well as tocopheryl acetate, also known as vitamin E. For intraindividual ointment comparison, each study participant was given all three ointment products. All study participants were instructed to apply the ointments once daily to a previously defined skin or scar area for a minimum period of 28 days (see Figure 1 ). All three areas to treat were marked precisely on a scheme (see Figure 1 ). Several in vivo and in vitro studies have shown that dexpanthenol may assist wound healing in all of the three stages through modulation of inflammation, support of cell proliferation, and protection from infection and free-radical damage [ 27 ]. Alhydran ® is a medical moisture retention cream (MMRC), which is a type of oil in water emulsion with freshly processed pure Aruba aloe vera gel, oils, and other fatty ingredients. With its aloe vera component, it is described to have a moisturizing effect combined with an occlusion effect through the fatty acids [ 31 ].

Rosa spp., commonly known as rosehips, are wild plants that have traditionally been employed as herbal remedies for the treatment of a wide range of disorders. Rosehip is a storehouse of vitamins, including A, B complex, C, and E. Among phytonutrients, vitamin C is found in the highest amount. As rosehips contain significant levels of vitamin C, they are perfect candidates for the development of skincare formulations that can be effectively used in the treatment of different skin disorders (i.e., scarring, anti-aging, hyperpigmentation, wrinkles, melasma, and atopic dermatitis). This research focuses on the vitamin C content of several <i>Rosa</i> sp. by their botanical and geographic origins, which according to research studies are in the following order: <i>R. rugosa</i> > <i>R. montana</i> > <i>R. canina</i> > <i>R. dumalis</i>, with lower levels in <i>R. villosa</i> and <i>R. arvensis</i>, respectively. Among rosehip species, <i>R. canina</i> is the most extensively studied species which also displays significant amounts of bioactive compounds, but also antioxidant, and antimicrobial activities (e.g., against <i>Propionibacterium acnes, Staphylococcus aureus, S, epidermis</i>, and <i>S. haemolyticus</i>). The investigation also highlights the use of rosehip extracts and oils to minimise the harmful effects of acne, which primarily affects teenagers in terms of their physical appearance (e.g., scarring, hyperpigmentation, imperfections), as well as their moral character (e.g., low self-confidence, bullying). Additionally, for higher vitamin C content from various rosehip species, the traditional (i.e., infusion, maceration, Soxhlet extraction) and contemporary extraction methods (i.e., supercritical fluid extraction, microwave-assisted, ultrasonic-assisted, and enzyme-assisted extractions) are highlighted, finally choosing the best extraction method for increased bioactive compounds, with emphasis on vitamin C content. Consequently, the current research focuses o Regarding phytocompounds, the pseudo-fruits and seeds are important sources of phenolic compounds (i.e., phenolic acids and anthocyanins), vitamins (C and E) ( Ogah et al., 2014 ; Koczka et al., 2018 ), and polyunsaturated fatty acids (PUFAs) with significant antioxidant activity ( Angelov et al., 2014 ). Rosehip oil (RO) is extensively used in multiple industry sectors, including pharmacy, cosmetics, and perfumery. Trans -retinoic acid, known for its rejuvenating qualities is present in large amounts in the essential oils extracted from rosehip seeds ( Kiralan and Yildirim, 2019 ). It is important to consider differences in plasma saturation when determining the effectiveness of dietary supplements for increasing skin’s vitamin C levels. 3.1 Topical rosehip application as a treatment against different skin disorders: Effects on scarring Restoring anatomical patterns and (partially) normal skin function is the outcome of the complex process, known as wound-healing ( Kasuya and Tokura, 2014 ). Three steps may be distinguished in the process, including remodelling, proliferation, and inflammation, which ultimately lead to scar formation. Attempts have been undertaken to further comprehend the fundamental processes and to develop appropriate therapies in order to enhance wound-healing and mitigate scar formation. Unfortunately, the progress made thus far has not been sufficient since there is a lack of useful treatments for fibrosis and skin damage. The epidermis and dermis make up the complex architecture of the skin. Both layers include a variety of cell types, including keratinocytes, fibroblasts, Wound-healing is a complex process involving remodelling, proliferation, and inflammation, leading to scar formation. Natural medications like Rosa sp. have shown potential in wound-healing, with RO treatment resulting in faster healing, improved reconstruction of collagen, increased fibroblast proliferation, and decreased infiltration of inflammatory cells. RO also contributes to the shift in macrophage phenotypes, enhancing wound healing. Applying RO to wounds can prevent the expression of transforming growth factor (TGF)-β1 and α-SMA, thereby enhancing skin fibrosis. Particularly in the form of AA, and a pH value beneath four helps the product to be absorbed by the skin ( Nusgens et al., 2001 ; Humbert et al., 2003 ). From a clinical perspective, it is significant to take into account that the effectiveness of vitamin C serums is concentration-dependent, but only to a maximum of 20% ( Farris, 2009 ). Adequate photo-protection requires a sustained stock of vitamin C, which can be attained by applying the vitamin every 8 hours ( Matsuda et al., 2008 ; Talakoub et al., 2009 ). Earlier investigations have demonstrated that Rosa spp. Vitamin C not only hydroxylates the collagen molecule to stabilize it but also triggers fibroblasts to produce collagen mRNA ( Tajima and Pinnell, 1996 ; Traikovich, 1999 ; Duarte et al., 2009 ). Reduced collagen synthesis is responsible for the manifestations of scurvy (i.e., bleeding gums disease), a vitamin C-deficient condition. According to clinical research, applying vitamin C topically to human skin of any age enhances the formation of collagen ( Burke, 2007 ; Farris, 2009 ). Studies on rosehips have shown the potential role in collagen synthesis and cell membrane longevity. sylvestris , and S. nigrum ), it significantly increases wound healing, re-epithelialization, and formation of epidermal granulation tissues. This suggests that rosehip could be used in skincare formulations as a natural product for healing properties, but also a potential treatment for acne vulgaris. Overall, vitamin C−derived from rosehips neutralizes and eliminates environmental contaminants and UV radiation damage to the skin. It is primarily concentrated in the skin’ s epidermis and plays a crucial role in the antioxidant defence system. Also, when combined with other vitamins it minimizes oxidative damage.