UF Researchers Probe Epilepsy Drug's Effect On Scars

February 10, 2004

GAINESVILLE, Fla. — Giving a common antiseizure drug to patients with scars on their bodies may improve the cosmetic appearance of the scars, scientists at the University of Florida’s Evelyn F. and William L. McKnight Brain Institute report in the current issue of Dermatology Online Journal.

In a preliminary study, psychiatry researcher Dr. Nathan Shapira discovered improvements in the physical appearance of scars in patients who received low oral doses of topiramate, a drug usually prescribed for patients with epilepsy. However, the pilot study did not address a possible “placebo effect,” which takes place when people show improvement even though they’ve received an inactive drug or treatment.

Topiramate has been used for many years as an antiseizure medication and is already approved by the Food and Drug Administration for that purpose.

The next step in determining whether the drug is useful for scars is to compare patients who receive topiramate with a similar group of patients given an inactive drug, said Shapira, who is a principal in a patent application submitted by the University of Florida for topiramate’s use for wound healing.

However, the findings suggest the drug holds promise for patients self-conscious about scars from acne, surgery, burns and trauma, he said. The researchers know of no effective oral drug treatments for scars.

“It’s interesting to think that a compound that helps calm seizures might have some completely different effect on the body,” said Shapira, an assistant professor in the psychiatry department at UF’s College of Medicine. “The age of the scars, characteristics like color and height of the scars, and the failure of other types of previous treatments in these patients all argue for the potential of this compound. A longstanding scar changing by itself is not likely.”

During the study, 10 adults who had discolored or raised scars for at least two years were given 15 milligrams of topiramate orally for one month. Nine patients were women. If the patient showed minimal improvement, the dosage was increased to 30 milligrams, more than five times less than the standard dosage of the drug when given to patients with epilepsy, Shapira said.

Using a standardized scale that measures changes in a medical condition over time, physicians assessed two patients as being “very much improved,” four as “much improved” and four as “minimally improved.”

In addition, two independent medical reviewers blindly reviewed photos taken of the scars. One medical reviewer correctly arranged the before- and after-treatment pictures for all study participants, and the other reviewer correctly arranged the pictures for nine of 10 subjects.

“I hope the publication of these findings spurs an independent evaluation,” said Dr. Arthur Huntley, a dermatology professor at the University of California Davis and publisher of Dermatology Online Journal. “Scars do improve with time, but the findings presented by Shapira were much better than would be expected. I hope his results can be verified by others. It’s too early to conclude that topiramate really works for scars, but the findings do merit a double-blind trial.”

Adverse effects were generally mild, commonly relating to language problems, such as word-finding, and sleep disturbances.

The preliminary results stem from investigations McKnight Brain Institute psychiatrists are doing into Prader-Willi syndrome, a genetic disease characterized by a patient’s short stature, learning disability and insatiable appetite, and often by obesity and self-injurious behavior.

“We were trying to get an effect on appetite and weight, which we did not see,” Shapira said. “But we did see an effect on self injury and what appears to be improved wound healing. After that, we designed a follow-up study to look at topiramate’s effects on skin. This is an example of where you follow the lead of the data. I’m a psychiatrist that happened to notice something that took me to dermatology, a completely different field.”