Treatment of keloids remains challenging
Many tools for managing keloids in Brown and Black skin exist, but prevention is still key (1,100 words, 5 minutes 30 seconds)
Keloids are quite common in Brown and Black skin, particularly in younger individuals, said Dr. Yvette Miller-Monthrope and Dr. Vincent Richer in the July 31 edition of the Skin Spectrum Summit's Summer of Dialogue podcast series.
These two dermatologists discussed how keloid scarring can impact people's lives and the available treatments as part of this series on dermatology concerns in Brown and Black skin.
“The typical patient with keloids is otherwise young and healthy. They are often in their 20s or 30s,” said Dr. Richer, a Vancouver-based medical and cosmetic dermatologist and clinical assistant professor at the University of British Columbia.
“I did find a keloid on an 80-year-old the other day, but it is certainly over-represented in young adults. And we see it more on Asian, Brown and Black skin, definitely,” he said.
In addition to keloids being aesthetically unappealing, itchy and often painful, they can sometimes even lead to functional deficits, Dr. Miller-Monthrope said.
“I had one patient with a keloid that was spanning over their antecubital fossa [the inside of the elbow], and it was difficult for them to bend their arm,” she said. Dr. Miller-Monthrope is an assistant professor of medicine at the University of Toronto in the Division of Dermatology and currently works in Toronto as an academic dermatologist and dermatopathologist.
The two doctors talked about some of the treatment options available, noting there is no one gold standard treatment for these challenging scars. Among the treatments they discuss are:
Silicone patches
Intralesional triamcinolone acetonide injections
5-fluorouracil (5-FU)
Laser-assisted medication delivery
Surgical removal combined with another treatment to prevent a recurrence
Both clinicians emphasized that the easiest keloid to remove is one that does not develop in the first place. They recommend preventing conditions that can cause scarring—such as by treating acne aggressively—and choosing to forego elective surgeries such as mole removal where possible.
Bottom line:
There are many treatments for keloids available and being researched, but none are exceptionally safe and effective. Because of the impact on quality of life in young people with Brown and Black skin, preventing these scars is very important.
Listen to the complete podcast episode here.
From the literature on keloids
A comparison of intralesional verapamil and triamcinolone monotherapy in the treatment of keloids in an African population
This study evaluated outcomes in 70 patients who had their keloids treated with either intralesional verapamil (2.5 mg) or triamcinolone (40 mg). Keloid dimensions were measured before and after treatment using an electronic calliper. The patients' pain and itch symptoms were also evaluated at follow-up visits.
The investigators found that while the verapamil injection was comparably effective to triamcinolone for small-size keloids, only patients in the triamcinolone group had complete resolution of their pain and itch.
Outcomes of surgical excision and high-dose-rate brachytherapy for earlobe keloids
Investigators conducted a retrospective chart review of 14 patients with 14 earlobe keloids treated with surgical excision followed by high-dose-rate brachytherapy. All participants were of Hispanic or African descent, with Fitzpatrick skin types III (two patients), IV (seven patients), V (four patients) and VI (one patient). The researchers evaluated treatment outcomes in terms of keloid recurrence rates, complications, and patients' subjective satisfaction with the aesthetic results after 24 months of follow-up.
There were no complications to the procedures. Three of the patients had keloids recur, and three had mild signs of skin inflammation after the radiation treatment. Almost three-quarters of the participants rated their aesthetic results as 'very good'’
Quality of life in black African patients with keloid scars
This study was conducted to evaluate the impact of keloid scars on the Quality of Life of patients, using the Dermatology Life Quality Index (DLQI). Some 132 Black African patients with keloids and 3,612 with dermatoses but no keloids were recruited at a single teaching hospital.
The authors found that 53.33% of the keloid patients experienced pain from the scar, and 95.00% experienced pruritus. As well, 65.83% had psychological impacts from the keloids.
Pain, pruritus and functional disorders were associated with significant impacts on Quality of Life.
Suppurative keloids: a complication of severe keloid disease
Noting that some keloids show cystic cavities that give rise to acute inflammatory flares and oozing, researchers conducted a retrospective cohort study to learn the frequency and risk factors of these suppurative keloids (SKs).
Among the adult patients attending a specialized keloid clinic, the researchers found an SK rate of 26% for a mean keloid history of 17.2 years. The authors conclude that suppuration is a common complication in severe keloids—this might be due to pilosebaceous occlusion and inflammation.
VIDEO: Scar and Keloid Management | Andrew Vardanian, MD | UCLAMDChat
At the intersection of skin and society
The Canada Memory of the World Register has recently added two new collections of historical documents that speak to the lives of Black Canadians.
Part of UNESCO's Memory of the World Programme, the Register is a collection of historical documents gathered to provide universal access to artistic, cultural, economic, geographic, linguistic, political, scientific, spiritual and identity-based heritage.
These new additions are two of three collections added on July 20, 2021.
According to a press release from the Register, they are adding:
The court records of Viola Irene Desmond from the Nova Scotia Archives. Viola Irene Desmond (née Davis, 1914–1965) was an African Nova Scotian businesswoman and entrepreneur. Her case is the first known legal challenge against racial segregation laws by a Black woman in Canada. In 2010, Desmond was the first person in Canada to be granted a posthumous free pardon. Her image now appears on the Canadian $10 bill.
The personal document collection of Alvin D. McCurdy from the Archives of Ontario.
According to the release, Alvin D. McCurdy worked to preserve the heritage of the Black communities of Amherstburg and elsewhere in Southern Ontario when traditional archives and other established institutions were only peripherally interested in Black history records. The McCurdy collection, or fonds, is an important collection for understanding the histories and stories of Amherstburg's role in the Underground Railroad.
A complete list of collections in the Canada Memory of the World Register is available here: https://en.ccunesco.ca/our-priorities/memory-of-the-world/canada-memory-of-the-world-register
This Week
August is Psoriasis Awareness Month in the US
Aug. 9 is International Day of the World's Indigenous Peoples
Aug. 12 is International Youth Day
Something to think about in the week ahead. . .
Next Week
The Summer of Dialogue: Focus on the Black and Brown Dermatology Patient podcast continues.
The Summer of Dialogue is a summer-long podcast discussion series on Black skin health. In recognition of the persistent health gaps that BIPOC Canadians experience, this program will promote and advance medical knowledge and cultural competence. The podcast series will conclude with a live colloquium to be held on Aug. 21, 2021.
Registration for the colloquium and more information on the Summer of Dialogue is available at https://www.skinspectrum.ca/summer