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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Aging through the Decades

By Media Coverage

Source: Dermatology Times

Dermatologists have always known that different ethnic skin types age at different rates, but until now there hasn’t been clear evidence that these phenotypic differences have a pathophysiologic and histologic basis. Maritza Perez, M.D., Icahn School of Medicine at Mount Sinai, New York, presented new research illustrating the aging process across the decades and how it differs between ethnic skin types. Read more.

References:

“The Evaluation of the Aging Process Across Ethnic Variations,” Maritza Perez, M.D. Skin of Colour Seminar Series. 5-6 May, New York. May 5, 2018

Cosmetic Needs Differ for Skin of Color Patients

By Media Coverage

SOURCE: Dermatology Times

If a Caucasian patient comes to my practice they will be looking for treatment for sun damage, wrinkles and capillaries, whereas, if it is a person of color, they will be looking for treatment for dark spots — dark spots from hair, dark spots from melasma, dark spots from scars, says Eliot F. Battle, Jr., M.D., CEO and Co-Founder, Cultura Dermatology and Laser Center, Washington, D.C.

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UV Protection Still Lags in Skin of Color

By Media Coverage

Source: Dermatology Times

NEW YORK ― In skin of color, ultraviolet (UV) and visible light protection are crucial to maintaining a healthy and youthful appearance. Although the mechanism by which UVA, visible light, and infrared damages the skin is still under study, reactive oxygen species (ROS) are thought to play a major role, said Steven Q. Wang, M.D., at the Skin of Color Seminar Series held here in April. Read more.

Patient received chemical peel

Staying Ahead of the Game in Skin of Color Dermatologic Care

By Sessions

The optimal treatments for skin of color patients seeking dermatologic care are constantly changing. Keeping up to date with the latest advances in the field, both medical and aesthetic, can prove to be difficult and overwhelm even the most brilliant dermatologist. With a growing recognition that constant training and direct access to skin of color thought leaders is necessary to be at the forefront of trending evidence-based research, leading experts in the field are joining forces to ensure skin of color patients receive the care they need. Among these experts are Dr. Andrew Alexis and Dr. Eliot Battle, co-chairs of the Skin of Color Seminar Series, the largest CE event dedicated to patients with skin types III – VI. With an unparalleled agenda and an esteemed faculty of KOL’s, this is probably THE event all dermatologists wanting to stay up to date on all skin of color medical and aesthetic advances must attend.

Always a highlight of the Skin of Color Seminar Series, attendees have the rare opportunity to ask their most pressing questions to the world’s top skin of color dermatology experts.

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Skin Type Classification: A Decennial Perspective

By SOC Manuscripts

Source: Journal of Drugs in Dermatology April 2018

Wendy E. Roberts MD FAAD 

The intent of this brief communication is to revisit the Roberts Skin Type Classification System published by Journal of Drugs in Dermatology (JDD) in 2008 with a 2018 lens and provide additional information for its wider acceptance and implementation. The key points of this communication are that the 2010 US census indicates rapid growth of the multiple race population up 30-50% from the 2000 census, cosmetic procedures have increased from 9.5 million to 12.8 million over the same 10 year period, and cosmetic procedures in SOC patients have increased 6% over the same 10 year period. We have come very far in our knowledge of skin safety and colorblind technology, however, as we experience rapid globalization and increasing diversity of traditionally diverse populations, this classification system is even more relevant now than it was 10 years ago. What standard are we using to predict our diverse patient outcomes to skin insult, injury, and inflammation? Why do we still use the limited Fitzpatrick Phototype System to communicate safety when the system does not address dyspigmentation and scarring, the most frequent complications in ill-fated skin trauma?

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Psoriasiform Pemphigus Foliaceus in an African American Female: An Important Clinical Manifestation

By SOC Manuscripts

Source: J Drugs Dermatol. 2018;17(4):471-473

Evan Austin BS, Jillian W. Millsop MD, Haines Ely MD, Jared Jagdeo MD MS and Joshua M. Schulman MD

A 50-year-old African-American woman presented to the dermatology clinic with a pruritic eruption of 3 years’ duration. On clinical examination, the patient had well-demarcated, pink, atrophic plaques and superficial erosions over the inframammary folds and mid-chest. She also had well-demarcated, hyperpigmented, hyperkeratotic scaly plaques over the abdomen, suprapubic region, elbows, knees, and back with sporadic small superficial blisters. A punch biopsy of the right abdomen was performed and revealed psoriasiform epidermal hyperplasia, focal parakeratosis, and acantholysis throughout the superficial spinous and granular layers. Only a sparse inflammatory infiltrate was present in the underlying dermis. Clinical and histological findings supported the diagnosis of pemphigus foliaceus (PF), but psoriasis was included in the differential diagnosis due to the presence of discrete plaques with an erythematous border. We hypothesize that patients with psoriasiform presentations of PF may be misdiagnosed with plaque psoriasis. It is important to distinguish between PF and psoriasis as there is evidence that ultraviolet light, a common treatment for psoriasis, may exacerbate PF. We document and highlight this atypical psoriasiform presentation of PF in a patient with skin of color to raise awareness and improve diagnosis and outcomes.

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