Balancing keloid risk in elective surgery
Balancing keloid risk in elective surgery
Patient history of scarring, body site and other factors contribute to the potential for abnormal scar formation (1,150 words, 5 minutes 45 seconds)
When patients at risk of keloid scarring inquire about elective minor dermatologic surgery, there needs to be a conversation about risk mitigation, said Dr. Renée Beach during a discussion at the Colloquium on Black Skin on Saturday Aug. 21.
Patients looking for specific elective surgeries, such as mole removal, could potentially experience worse cosmetic outcomes if the surgery results in out-of-control scarring.
Dr. Beach practices medical and cosmetic dermatology at DermAtelier on Avenue in Toronto and is an assistant professor at the University of Toronto.
“I think [whether to go forward with surgery] is a matter of deciding partially by history,” she said. “For example, when they last had something removed, and what was the result. I will take a look at their most recent scar to get a sense of how they healed.”
The body site for the surgery also matters, she said. “The flexor [surface of the] arm will heal much differently than the scapula or trapezius area.”
A third critical consideration Dr. Beach mentioned was whether or not the patient was prepared to take responsibility for any necessary aftercare.
Patients will need to consider aspects of these elective surgeries, including:
Is the patient aware of the potential outcomes, including keloid formation?
Is the patient aware of the need for follow-up visits, whether for suture removal, scar refining treatments, or another purpose?
Is the patient prepared to take necessary at-home care steps, including scar management treatments such as the use of silicone patches?
Bottom line
Elective dermatologic surgery can have good cosmetic outcomes in patients at risk of keloids, but care needs to be taken, and a clear conversation is needed. Suppose a physician has a patient who does not appear to understand the potential outcome, or the physician does not think the patient can perform necessary follow-through to optimize healing of the scar or improve its cosmesis. In that case, the physician should be comfortable to suggest the patient not undertake the surgery.
From the literature on keloid scars and prevention
Keloid scars arising after follicular unit extraction hair transplantation
This case report presents a follicular unit hair extraction patient who developed keloid scarring at the donor site. The authors note that keloids are more frequently associated with strip harvesting hair transplantation. They write that hair transplant practitioners should be aware of this potential complication when considering hair restoration in their patients.
Location propensity for keloids in the head and neck
This literature review looked at 1,445 keloid studies collected through Jan. 2020. The final analysis, covering 1,598 head and neck keloids, led the authors to conclude that the ear, preauricular regions, bearded facial regions and submandibular and submental sites had the highest keloid development. Investigators noted the lowest risk was in the central face.
The authors conclude that region-specific risk factors should be considered before performing elective procedures in keloid-susceptible individuals.
Safety of laser hair removal in patients receiving systemic isotretinoin for acne vulgaris
Noting that there have been reports of keloid and other scar formation after laser hair removal in patients treated with isotretinoin for acne, the authors of this study investigated the safety of three types of lasers in these patients.
The 52 acne patients in the study underwent laser hair removal with alexandrite, diode, and Nd:YAG lasers. Their outcomes were compared to a control group. The mean interval between the start of the patients' acne therapy and their first laser treatment was 39.3 days.
Investigators observed no significant difference in side effects between the isotretinoin-treated and control groups, and neither keloid nor scar formation was seen in either group.
Emerging insights into the immunological aspects of keloids
This paper looks at the literature on the potential immunological mechanisms of keloids. The review illustrates some of the immunological processes involved in classifying immune cells. The authors also discuss possible immune-related reasons for the recurrence of keloids and inter-cell communication and inflammation-related signalling pathways involved in keloid pathogenesis.
VIDEO: How cosmetic eyelid surgery is performed on darker skin while avoiding keloid scars
At the intersection of skin and society
First Nations University of Canada (FNU) in Regina, Sask. is collaborating with a Mexican researcher and Indigenous elders and knowledge-keepers to understand traditional medicinal plants better.
CBC News reports that biotechnology researcher Ana Karime Arellano Franco, a 24-year-old undergraduate at Instituto Tecnológico de Monterrey in Mexico, has been working remotely with the Indigenous knowledge and science department FNU. She has collaborated with Dr. Vincent Ziffle, assistant professor of chemistry at FNU, reported CBC News. Elder Archie Weenie also guided Arrellano Franco from Sweetgrass First Nation, located 26 kilometres west of North Battleford, Sask.
Arellano Franco’s work involved identifying, extracting and analyzing the medicinal properties of seven common plant species. Some of those species are wild sarsaparilla, Canadian mint, prairie rose and purple coneflower.
“I am emphasizing the molecules we’re looking for in these plants and how we can synthesize them using organic chemistry in a respectful way to the First Nations,” the news outlet quoted Arellano Franco as saying.
Being respectful in this context “means emphasizing how [the plant species] were being used in the past. For example, purple coneflower has been used to treat throat infections, and it’s being researched for the same purposes, for its antimicrobial purposes,” said Arellano Franco.
“But we need to say First Nations have been using these plants in this way, and that is why we are researching them. And how can we use these molecules without exploiting [First Nations]?”
Elder Weenie told CBC News that many Indigenous people are hesitant to share their knowledge of medicinal plants.
“Say I talked about something so powerful, then you are trying to grab it, misuse it. So old people are careful what they reveal,” Weenie said.
“If it’s going to help the individual and they’re sincere about it, I will share.”
This week
Oct. 24-30 is Canadian Intensive Care Week
Oct. 29 is World Psoriasis Day
Something to think about in the week ahead...
Skin Spectrum Summit, Nov. 4 & 6, 2021
Registration is open for the 7th annual Skin Spectrum Summit, which starts next week on Nov. 4. Readers of Skin Spectrum Weekly are encouraged to register for this event by clicking here.
The conference secretariat is pleased to confirm that the Summit has been certified by the College of Family Physicians of Canada and the Ontario Chapter for up to 6.75 Group Learning credits.
Other great news this week is the announcement of more confirmed faculty for this year’s Summit. These additional faculty include:
Dr. Jenna Lester, founder and director of the University of California San Francisco’s Skin of Color Clinic
Dr. Jaggi Rao, scientific and artistic dermatologist, skin and cosmetic surgeon, researcher, author and educator
Dr. Brian Kunimoto, founder and director of the Vancouver General Hospital/University of British Columbia Wound Healing Clinic
Drs. Lester, Rao, and Kunimoto join curriculum chairs Drs. Gary Sibbald, Danielle Marcoux and Jason Rivers, as well as these new and returning faculty members:
Dr. Marissa Joseph
Dr. Joel Claveau
Dr. Vincent Richer
Dr. Renita Ahluwalia
Dr. Bolu Ogunyemi
Dr. Afsaneh Alavi
Dr. Heather Woolery-Lloyd
Dr. Veronica McKinney
Dr. Rachel Netahe Asiniwasis
Dr. Monica Li
Dr. Renée Beach
Dr. Shafiq Qaadri
Dr. Victoria Smart