Overall, I recommend using onion extract gels like Cicatricure and Mederma for low risk scars:
That's because the clinical evidence on onion extract is still mixed. 🤔
On the other hand, I recommend using silicone gels or silicone sheets for high risk scars:
That's because silicone is safe, supported by decades of clinical studies, and recommended by leading dermatologists in the International Clinical Recommendations on Scar Management.
I also like that Cicatricure includes additional agents like centella asiatica (a.k.a. tigergrass) to promote wound healing, glycerin and aloe vera to improve hydration, chamomile extract to soothe sensitive skin, and bergamot fruit oil for fragrance. Cicatricure is also alcohol-free.
In contrast, Mederma only includes allantoin, panthenol, and hyaluronic acid for hydration.
Finally, Cicatricure recommends applying its scar gel 4x a day while Mederma is only 1x a day. However, it's best to apply an onion extract gel at least twice a day for continuous coverage.
My Verdict: In my opinion, Cicatricure is a better and cheaper version of Mederma with a more extensive ingredient list to help minimize scar formation and maximize recovery results.
In other words, I recommend using Mederma for less serious wounds, such as mild burns, cuts & scrapes, bruises & accidents, and other minor injuries.
That's because the key ingredient in Mederma Advanced Scar Gel is onion bulb extract (a.k.a. Cepalin in Mederma's marketing materials and allium cepa in the ingredient list).
According to the 2014 International Clinical Recommendations on Scar Management (Part 2), a highly influential research paper authored by the world's leading experts on scar treatment, there's conflicting evidence on the effectiveness of onion extract for scars.
Some studies showed positive evidence, like the original clinical trial by Draelos et al. (2012) that was sponsored by Merz Pharmaceuticals (the parent company of Mederma).
In short, this study found a statistically significant difference in scar appearance between Mederma-treated scars (test group) and non-treated scars (control group) after 4-8 weeks.
However, there's a number of major flaws with this study:
Other studies found that onion extract was no better than similar topical treatments but resulted in more frequent side effects (itchiness, redness) that caused patients to stop using it. (source: International Wound Journal, 2021)
In addition, many studies used multiple active ingredients in their formulations which made it more difficult to isolate the effects of onion extract. (source: Dermatologic Surgery, 2014)
Finally, here's my personal opinion of Mederma Advanced Scar Gel based on 6+ months of using it on my chest keloids:
My Verdict: Taking into account the key ingredients, clinical studies, and my own experience, I recommend Mederma Advanced Scar Gel for low risk scars as the medical evidence is mixed. Mederma may help minimize scars from minor injuries and accelerate the recovery process.
For high risk scars, however, I recommend using a silicone gel or silicone sheet because it's safe (no side effects), clinically proven for scar treatment, and reasonably affordable.