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- Presentation
Update on Keloids
Description
In this presentation, Dr. Eva Kirby, a dermatologist specializing in diverse skin complexions at Cornell, discusses recent advancements in understanding and treating keloids, which are thickened scars caused by excessive collagen formation post injury. She emphasizes the need for more research in this underexplored field and introduces new keloid assessment tools like the Keloid Area and Severity Index and the Detroit Keloid Scale, which focus on measuring both the scarring severity and its impact on patients' quality of life. Dr. Kirby details the pathological mechanisms behind keloids, including the role of fibroblasts and inflammatory cells in collagen overproduction, and addresses the often-overlooked symptoms of pain and itch associated with keloids. Various treatment options are explored, starting with intralesional steroids, advancing to combination therapies like Kenalog and 5-Fluorouracil, and introducing innovative therapies such as botulinum toxin and oral pentoxifylline, which show promise in reducing keloid recurrence and alleviating symptoms. Cryotherapy and brachytherapy are also reviewed, with Dr. Kirby recommending their use in specific cases to ensure effective management of keloidal scars. Overall, she encourages more dermatologists to engage with keloid treatment and research, highlighting the importance of understanding their complex pathology to improve patient outcomes.
View moreConclusions
- Keloids are a fibroproliferative disorder initiated by dermal injuries, leading to excessive collagen production and scarring.
- Understanding the pathogenesis of keloids involves recognizing the roles of various growth factors and immune responses, particularly the influence of TGF-beta.
- New assessment tools like the Keloid Area and Severity Index (KASI) and Detroit Keloid Scale (DKS) provide better evaluation methods for keloid severity and impact on quality of life.
- Combination therapy using intralesional Kenalog and 5-fluorouracil is recommended for treating keloids that are unresponsive to monotherapy.
- Botulinum toxin shows promise in reducing keloid tension and proliferation, though its cost can be a barrier to use.
- Pentoxifylline demonstrates effectiveness in reducing keloid recurrence when used post-surgery alongside intralesional Kenalog.
- Dupilumab and JAK inhibitors present a potential for fibrosis reduction, warranting further investigation in keloid management.
- Cryotherapy is an effective treatment for large pedunculated keloids, improving symptoms and aesthetics.
- Brachytherapy and immediate postoperative treatments like ILK or ILF with 5-FU are critical to minimize keloid recurrence post-excision.
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