Monthly Archives

July 2018

Keloids skin of color update Baldwin

Updates on the Prevention and Management of Earlobe Keloids

By Skin of Color Update Agenda

This article features a recap of Dr. Hilary Baldwin’s talk on the etiology, risk factors, and treatment of keloids at the 2018 Skin of Color Seminar Series, now known as the Skin of Color Update. Dr. Bridget Kaufman, onsite correspondent for the meeting, shares highlights directly from the talk. Dr. Baldwin focused on earlobe keloids (cartilage piercing keloid) in particular, which may present with several different morphologies: anterior button, posterior button, wraparound, dumbbell, and lobular. *Clinical pearls* from this session are bolded, underlined and marked with asterisks.

Some patients develop cartilage keloids and others do not. Based on a study of 220 patients at Kings County Hospital, there appears to be no difference in rate of cartilage piercing, metal sensitivity, types of earrings worn, piercing method, hormonal influences, or age at piercing between keloid formers and non-keloid formers.  In the keloid former group, 12.8% of patients developed keloids at the first piercing, and the risk of keloid formation dramatically increased at each piercing thereafter (70.2% risk for 2nd piercing).

Important Points:

*Ear pierces on babies have a 0% risk of keloids*

*Piercings done pre-menarche have a significantly lower risk of keloids than those performed post-menarche*

*First pierces rarely keloid*

*The chances of subsequent pierce keloiding in a keloid former is at least 20% or higher*

*Earlobe keloids are significantly easier to treat than classic keloids on the body.* Earlobes are a discrete tissue with little to no tension, pressure dressings can be used, and patients tend to be very motivated and compliant. *For surgery alone, recurrence rate on the ear is 39-42% (vs. 100% on body). Surgery plus corticosteroids and surgery with radiation therapy for earlobe keloids are associated with a 1-3% (vs. 50% on body) and 0-25% (same for body) risk of recurrence.* Imiquimod helps prevent keloid recurrence when used on the earlobes, but does not appear to be effective on other body parts.

Dr. Baldwin’s method for excising dumbbell keloids called *dumbbell keloids for dummies:*

  • Shave off anterior button
  • Shave off posterior button
  • Measure diameter of keloid core
  • Select punch to be at least 1mm wider than core
  • Stabilize and punch through to a tongue depressor
  • Suture right/left anteriorly and superior/inferior posteriorly

Unfortunately, not all keloids can be surgically excised. The major dogma of keloid surgery is “don’t leave any keloid tissue behind.” *Hilary’s dogma of earlobe keloid surgery is “a non-functional earlobe is a treatment failure.* Dr. Baldwin performed a study in 5 patients in whom complete removal of keloids would leave a non-functional earlobe. She sculpted the keloid to earlobe shape, injected interferon-alpha 2b 1.5-million units/cm, covered the wound with a compression earring, and allowed for secondary intention healing. In the patients who completed therapy, there was no uncontrollable recurrence at 4-6 year follow-up, although all patients are continuing the use of pressure earrings. Based on these results, *the combination of targeted keloid removal, interferon-alpha 2b injection, and pressure earrings may be an option for patients with large, difficult-to-treat keloids.*

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Register for Skin of Color Update for lectures and pearls on keloids and more.

Poster Session

Poster Interview: Socioeconomic and Geographic Barriers to Dermatology Care in Urban and Rural U.S. Populations

By Skin of Color Update Agenda

Brianna Olamiju, Next Steps Correspondent, interviewed Toral S. Vaidya, Medical Student at the University of Cincinnati College of Medicine, to dig deeper on her research study titled “Socioeconomic and Geographic Barriers to Dermatology Care in Urban and Rural U.S. Populations” recently published in theJournal of the American Academy of Dermatology and presented at the Skin of Color Seminar Series (now Skin of Color Update) in May 2018.

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Avoid Antibiotics for Acne Treatment When Possible

By Media Coverage

Source: Dermatology Times

Years ago antibiotics were used to treat acne because it was thought that the condition was an infectious disease, says Dr. Hilary Baldwin of the Rutgers Robert Wood Johnson Medical School in New Jersey. However, it is now realized that while Propionibacterium (P) acnes is implicated in the pathophysiology of the condition by producing an inflammatory cascade, acne is not the result of a bacterial infection because all adults have P. acnes in follicles and the severity of acne does not correlate with P. acnes counts.

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Skin of Color Perez skin Cancer

Skin Cancer Detection and Treatments in Latino Patients

By Skin of Color Update Agenda

During the 2018 Skin of Color Seminar Series (now the Skin of Color Update), Dr. Maritza Perez, one of the foremost leaders in skin of color dermatology, took attendees inside the world of the U.S. Hispanic population shedding light on the sociological diversity, cultural lifestyle hazards, and the healthcare disparities that increases their risk of deadly melanomas. Many Hispanics believe erroneously that they are less likely to get skin cancer, a dangerous preconception shared with many physicians who believe that this population is invulnerable to skin cancer, resulting in a delay in diagnosis and an unnecessary higher mortality rate.

Next Steps correspondent, Brianna Olamiju, reports back on Dr. Perez’s lecture and shares high- yield information all dermatologists should know.

 

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