The conjugated triterpenic acids undergo enterohepatic circulation and are recovered in the feces as unchanged triterpenic acids, probably due to hydrolysis of the conjugates by the intestinal microflora. Asiaticoside is also hydrolyzed to asiatic acid by the intestinal flora. In the treatment of keloids and hypertrophic scars which are in the active stage. Keloids are recognized clinically as a proliferation of abnormal and disorganized connective tissue. They often appear without cause, whereas hypertrophic scars consist of an abnormal but organized proliferation of connective tissue.
Keloids appear in the healing phase of a surgical or traumatic wound.
Only scar tissue showing chronic inflammatory reactions are modified by Madecassol. Reproduction studies in animals have not shown teratogenic or embryotoxic effects. The dosage in children under 3 years of age has not been established and such use is not recommended at this time unless, in the opinion of the physician, the need for the treatment with Madecassol justifies the risk. A single case of purpura has also been observed in an elderly bedridden patient. The reaction was generalized, but not serious, and rapidly resolved after stopping treatment.