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.

Treatments for breast cancer can have an array of adverse effects, including hair loss, scarring, and irritated skin. These physical outcomes can, in turn, lead to body image concerns, anxiety, and depression. Fortunately, there is growing evidence that certain cosmetic therapies can improve patient self-image. Here we review various cosmetic treatment options including hair camouflage, eyebrow and eyelash camouflage, treatments for hirsutism, nipple and areola tattooing, post-mastectomy scar tattooing, treatments for dry skin/xerosis, removal of post-radiation telangiectasias, and lightening of post-radiation hyperpigmentation. For each patient concern, we report potential procedures, clinical evidence of impact on quality of life, special considerations, and safety concerns. This article aims to equip dermatologists with resources so that they may effectively counsel breast cancer survivors who express treatment-related cosmetic concerns.

Alopecia, the loss of hair on the scalp and/or body, experienced by millions of people worldwide, can be a very debilitating condition. Specifically, androgenetic alopecia (AGA), commonly known as male or female pattern baldness, is the most common form of hair loss. In the African diaspora, oils have traditionally been used to promote hair growth and recently, the application of hair oils to the scalp for the treatment of alopecia has become increasingly popular. With the recent surge of hair oil usage in the Black community, more research is needed to determine the efficacy of hair oils, as most studies have primarily used mice subjects. This article reviews the existing literature to better understand the use of hair oils in the treatment of androgenetic alopecia. Specifically, we investigate the popular carrier oils, castor oil, and pumpkin oil as well as the essential oils, lavender, peppermint, rosemary, and tea tree oil.

Linear lichen planus pigmentosus (LPP) of the face is a rare variant of lichen planus, with only a few cases published in the literature.1 It is an inflammatory condition with unknown etiology, characterized by blue-gray hyperpigmented macules, and tends to affect sun-exposed areas of the head and neck.1-4 The pathophysiology of linear lichen pigmentosus is poorly understood, though it is postulated to be caused by T-lymphocyte autoimmunity against keratinocytes.5-7 LPP more frequently affects middle age woman and skin phototypes III-VI.1,3 Treatment for linear LPP is difficult and there is no established first-line therapy; however, tacrolimus ointment, topical corticosteroids, and various systemic agents have shown to be effective in improving the appearance.3,8,9 Prior reports have characterized linear LPP that follows the lines of Blashko as more commonly affecting the trunk.1 We present three cases of linear lichen planus pigmentosus (LPP) of the forehead, a unique novel presentation of linear LPP of the face. One of our cases also provides supporting evidence for tacrolimus to be used as a preferred therapy to treat linear LPP of the face; however, more research is needed to support this claim. To our knowledge, this case series is the largest case series of linear lichen planus pigmentosus (LPP) of the forehead to be reported. J Drugs Dermatol. 2023;22(1):94-97. doi:10.36849/JDD.7200.

Growing a cosmetic dermatology practice is an often complex and arduous task. Many different factors must be considered in order to build and maintain a successful clinical practice. Devices and injectables are both integral components to operating a comprehensive cosmetic dermatology practice. Aesthetic physicians seeking to grow their cosmetic practice in these areas must be aware of the numerous considerations-both more obvious and more subtle-that play a role in the decision-making process, including the local market, patient demand, clinic space, and physician experience and training. This contribution is focused on the factors that should be carefully considered when looking to grow a cosmetic dermatology practice with devices and injectables.