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Keloids

Keloids skin of color update Baldwin

Updates on the Prevention and Management of Keloids

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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 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.

Dr. Baldwin started by discussing why some patients develop 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*

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Successful Treatment of Keloid With Fractionated Carbon Dioxide (CO2) Laser and Laser-Assisted Drug Delivery of Triamcinolone Acetonide Ointment in an African-American Man

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Source: J Drugs Dermatol. 2017;16(9):925-927.

Ekaterina Kraeva MD, Derek Ho MD, and Jared Jagdeo MD MS

Keloids are fibrous growths that occur as a result of abnormal response to dermal injury. Keloids are cosmetically disfiguring and may impair function, often resulting in decreased patient quality-of-life. Treatment of keloids remains challenging, and rate of recurrence is high. We present a case of a 39-year-old African-American man (Fitzpatrick VI) with a 10-year history of keloid, who was successfully treated with eight sessions of fractionated carbon dioxide (CO2) laser immediately followed by laser-assisted drug delivery (LADD) of topical triamcinolone acetonide (TAC) ointment and review the medical literature on fractionated CO2 laser treatment of keloids. To the best of our knowledge, this is the first report of successful treatment of a keloid using combination therapy of fractionated CO2 laser and LADD with topical TAC ointment in an African-American man (Fitzpatrick VI) with excellent cosmetic results sustained at 22 months post-treatment. We believe that this combination treatment modality may be safe and efficacious for keloids in skin of color (Fitzpatrick IV-VI) and other patients. This case highlights the ability of laser surgeons to safely use fractionated CO2 lasers in patients of all skin colors.

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