Faculty Bibliography

BACKGROUND:Keloids are common in genetically predisposed individuals and in darker skin types, and treatment is especially challenging; the most commonly used therapeutic options return inconsistent results and often result in recurrence. Despite their prevalence and therapeutic challenges, keloids remain understudied and are often conflated with hypertrophic scars in the literature, though these conditions likely have distinct biomechanical etiologies. There remains a need for better optimization and comparison of existing treatment modalities to more effectively manage keloidal scarring. METHODS:Thirteen patients with two similar keloids or one large keloid completed four treatments of a fractionally ablative erbium YAG laser, followed by application of either triamcinolone 10 mg/mL solution to one keloid or one half of the keloid or 5-fluorouracil solution 50 mg/mL solution to the second keloid or the other half of the keloid. Photos and measurements of the keloids were taken at each visit. The Patient and Observer Scar Assessment Scale (POSAS) score was recorded by the participants and the blinded physician observer at each visit. Blinded dermatologist observers completed the Hamilton score based on the scar photographs. RESULTS:; there was not a statistically significant difference between the two (p = 0.56). Ten out of 13 patients were Fitzpatrick skin types IV-VI. There were no serious adverse events reported. CONCLUSION/CONCLUSIONS:In this pilot study of keloid patients, POSAS scores significantly improved after both laser-assisted TAC delivery and laser-assisted 5-FU delivery, with no statistically significant difference between the two treatment arms. However, there was a noted discrepancy in patient reports of post-procedural hyperpigmentation, with more patients experiencing this adverse effect within the 5-FU arm than in the TAC arm. While fractionally ablative laser-assisted drug delivery with either 5-FU or TAC is a safe and effective method to treat keloids, special attention should be paid to hyperpigmentation as a possible adverse effect in patients with darker skin tones, who are disproportionately affected by both keloids and hyperpigmentation.

BACKGROUND:HPV is a prevalent sexually transmitted infection (STI) associated with malignancies and condyloma acuminata (CA), with significant healthcare costs. Despite vaccine availability, vaccination rates remain low, highlighting the need for effective interventions to increase uptake. OBJECTIVE:To improve HPV vaccination rates among eligible individuals at a safety-net dermatology STI clinic. METHODS:A multiphase quality improvement program aimed to improve HPV education and vaccination rates was implemented in a dermatology STI clinic. The cohort included 175 patients with CA between August 2019 and December 2022. HPV vaccine education and immunization rates were measured. RESULTS:While counseling/education rates were high, vaccination initiation rates remained low before the onset of in-office HPV vaccine. In-office HPV vaccine administration demonstrated a 175% increase in vaccine initiation (p < 0.01). LIMITATIONS/CONCLUSIONS:This study had a relatively small sample size and was conducted in an urban, safety-net hospital; results may not be generalizable to smaller or rural practices. CONCLUSION/CONCLUSIONS:This quality improvement initiative successfully increased HPV vaccination rates at a safety-net dermatology STI clinic, demonstrating that in-office, same day vaccination for HPV was critical for the success. Our study highlights an effective approach toward improving vaccination rates for HPV and is a model for vaccine delivery.

All types of alopecia, including androgenetic alopecia, alopecia areata, and lichen planopilaris/frontal fibrosing alopecia, affect over half of men and women. Though a common dermatological experience, many patients with visible hair loss report significant psychological and social distress and, consequently seek treatment. Current existing therapeutic regimens have proven to be efficacious, though may result in various adverse effects and require lifelong use. Laser and light-based therapies have been emerging in the current literature as a safe and alternative treatment, but their utilization for treating alopecia is poorly understood. This review evaluates the existing evidence regarding the use of lasers in the treatment of various forms of alopecia. Overall, there has been promising evidence for potential alopecia treatment efficacy: low-level light therapy for androgenetic alopecia, fractional laser for androgenetic alopecia, and excimer laser for alopecia areata.

PURPOSE/OBJECTIVE:Acute radiation dermatitis (ARD) is common after radiation therapy for breast cancer, with data indicating that ARD may disproportionately affect Black or African American (AA) patients. We evaluated the effect of skin of color (SOC) on physician-reported ARD in patients treated with radiation therapy. METHODS AND MATERIALS/METHODS:We identified patients treated with whole breast or chest wall ± regional nodal irradiation or high tangents using 50 Gy in 25 fractions from 2015 to 2018. Baseline skin pigmentation was assessed using the Fitzpatrick scale (I = light/pale white to VI = black/very dark brown) with SOC defined as Fitzpatrick scale IV to VI. We evaluated associations among SOC, physician-reported ARD, late hyperpigmentation, and use of oral and topical treatments for RD using multivariable models. RESULTS:A total of 325 patients met eligibility, of which 40% had SOC (n = 129). On multivariable analysis, Black/AA race and chest wall irradiation had a lower odds of physician-reported grade 2 or 3 ARD (odds ratio [OR], 0.110; 95% confidence interval [CI], 0.030-0.397; P = .001; OR, 0.377; 95% CI, 0.161-0.883; P = .025), whereas skin bolus (OR, 8.029; 95% CI, 3.655-17.635; P = 0) and planning target volume D0.03cc (OR, 1.001; 95% CI, 1.000-1.001; P = .028) were associated with increased odds. On multivariable analysis, SOC (OR, 3.658; 95% CI, 1.236-10.830; P = .019) and skin bolus (OR, 26.786; 95% CI, 4.235-169.432; P = 0) were associated with increased odds of physician-reported late grade 2 or 3 hyperpigmentation. There was less frequent use of topical steroids to treat ARD and more frequent use of oral analgesics in SOC versus non-SOC patients (43% vs 63%, P < .001; 50% vs 38%, P = .05, respectively). CONCLUSIONS:Black/AA patients exhibited lower odds of physician-reported ARD. However, we found higher odds of late hyperpigmentation in SOC patients, independent of self-reported race. These findings suggest that ARD may be underdiagnosed in SOC when using the physician-rated scale despite this late evidence of radiation-induced skin toxicity.