Keloid Skin Flap Retention and Resurfacing in Facial Keloid Treatment.

OBJECTIVE: Facial keloids commonly occur in young patients. Multiple keloid masses often converge into a large lesion on the face, representing a significant obstacle to keloid mass excision and reconstruction. We describe a new surgical method that excises the keloid mass and resurfaces the wound by saving the keloid skin as a skin flap during facial keloid treatment. METHODS: Forty-five patients with facial keloids were treated in our department between January 2013 and January 2016. Multiple incisions were made along the facial esthetic line on the keloid mass. The keloid skin was dissected and elevated as a skin flap with one or two pedicles. The scar tissue in the keloid was then removed through the incision. The wound was covered with the preserved keloid skin flap and closed without tension. Radiotherapy and hyperbaric oxygen were applied after surgery. Patients underwent follow-up examinations 6 and 12 months after surgery. RESULTS: Of the 45 total patients, 32 patients were cured and seven patients were partially cured. The efficacy rate was 88.9%, and 38 patients (84.4%) were satisfied with the esthetic result. CONCLUSION: We describe an efficacious and esthetically satisfactory surgical method for managing facial keloids by preserving the keloid skin as a skin flap. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A Novel Treatment of Acne Keloidalis Nuchae by Long-Pulsed Alexandrite Laser.

BACKGROUND: Acne keloidalis nuchae (AKN) is a dermatological condition characterized by follicular-based papules and pustules that later form hypertrophic or keloid-like scars. Laser-assisted hair reduction such as 810-nm diode laser and 1,064-nm Nd:YAG laser have been used for treating AKN with promising results. OBJECTIVE: To evaluate the therapeutic effect and safety of alexandrite laser in the treatment of different lesions of AKN. METHODS: Seventeen male patients with AKN received 6 sessions of 755-nm alexandrite laser. Papule and pustule count, keloidal plaque size, pliability, tenderness, and itching were assessed at the fourth session and 4 weeks after the sixth session. Patient satisfaction and Dermatology Life Quality Index (DLQI) questionnaire were performed at the end of treatment. Patients were followed up for 3 months after the final treatment. RESULTS: There was a significant decrease in the mean papule, pustule count, keloidal plaque size, and pliability at the fourth and sixth laser sessions when compared with baseline. Reduction of the hair density in the treated area is the only complication observed, which was accepted by the patients because of its reversible course. There was a statistically significantly higher percentage of improvement in the early lesions (papulopustular) compared with late (keloidal plaque) lesions. By the end of laser sessions, DLQI scores were significantly reduced. Temporary hair loss was noted in 4 patients in the treated sites. No lesional recurrence was detected in the follow-up period. CONCLUSION: Using 755-nm alexandrite laser for treatment of AKN is a safe and effective procedure with low recurrence rates. Alexandrite laser can significantly improve the quality of life of those patients suffering from this disfiguring chronic disorder.

The efficacy and safety of the fractional radiofrequency technique for the treatment of atrophic acne scar in Asians: A meta-analysis.

BACKGROUND: The fractional radiofrequency (fRF) technique is a recently emerged technique. However, the exact outcomes of fRF for treating atrophic acne scar in Asians are still unclear. OBJECTIVE: To compare the clinical outcomes of fRF with the fractional laser technique in Asians with atrophic acne scar. MATERIALS AND METHODS: The databases MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Chinese National Knowledge Infrastructure (CNKI) were searched. Main clinical outcomes were participant-reported scar improvement, investigator-reported scar improvement, post-inflammatory hyperpigmentation (PIH), erythema duration, scab duration, and the pain level. RESULT: Six randomized controlled trials were included in this meta-analysis. The scar improvement was similar in both groups regarding participant-reported scar improvement (p = 0.48) and investigator-reported scar improvement (p = 0.89). However, the incidence of PIH in fRF group was lower in comparison with the laser group (p < 0.001). The average duration of erythema was shorter in fRF group than in the laser group (p < 0.001). The mean time for debridement was shorter in fRF group than the carbon dioxide fractional laser system (p = 0.02). The pain level did not differ significantly in the two groups (p = 0.53). CONCLUSION: Although some bias exists in our study, fRF appears to be a superior alternative for the treatment of atrophic acne scar in Asians.

Refractory acne keloidalis nuchae treated with radiotherapy.

Acne keloidalis nuchae (AKN) is difficult to treat, and the clinical response is usually poor. Few reports have been published about scarring alopecia treated with radiotherapy (RT). We report a case of AKN that had been refractory to various other treatments but which responded to RT with excellent clinical and cosmetic results.

Improving acne keloidalis nuchae with targeted ultraviolet B treatment: a prospective, randomized, split-scalp comparison study.

BACKGROUND: Acne keloidalis nuchae (AKN) is a chronic scarring folliculitis with fibrotic papules on the occipital scalp. Its treatment is limited and unsatisfactory. OBJECTIVES: To determine whether targeted ultraviolet B (tUVB) phototherapy will (i) improve the clinical appearance of AKN and (ii) induce extracellular matrix remodelling in affected lesions. METHODS: Eleven patients with AKN were enrolled in a prospective, randomized, split-scalp comparison study. One randomly selected side of the scalp was treated with tUVB up to three times weekly for 8 weeks. After week 8, both sides were treated for eight additional weeks. Assessment included lesion counts in two 3 × 3-cm regions of interest (ROIs), one on each side of the scalp (ROI-1: tUVB weeks 0-16, ROI-2: tUVB weeks 9-16), patient self-assessment and analysis of MMP1, MMP9, TGFB1 and COL1A1 mRNA expression by quantitative reverse-transcription polymerase chain reaction. RESULTS: Before treatment, the mean lesion count was similar between tUVB-treated and untreated sides (14·8 vs. 15·0). After 8 weeks of tUVB, the mean lesion count decreased significantly to 9·4 ± 1·2 (P =  0·03), with no change on the untreated side. With continued treatment, the mean lesion count in ROI-1 decreased further to 7 ± 1·5 (P = 0·04) after 16 weeks of tUVB. CONCLUSIONS: tUVB significantly improved the clinical appearance of AKN, led to patient satisfaction and was well tolerated.

Non-ablative 1550-nm erbium-glass and ablative 10 600-nm carbon dioxide fractional lasers for acne scars: a randomized split-face study with blinded response evaluation.

BACKGROUND: Non-ablative 1550-nm erbium-doped fractional photothermolysis systems (FPS) and 10 600-nm carbon dioxide fractional laser systems (CO(2) FS) have been effectively used to treat scars. OBJECTIVE: We compared the efficacy and safety of single-session treatments of FPS and CO(2) FS for acne scars through a randomized, split-face, evaluator-blinded study. METHODS: Eight patients with acne scars were enrolled in this study. Half of each subject's face was treated with FPS and the other half was treated with CO(2) FS. We used a quartile grading scale for evaluations. RESULTS: At 3 months after the treatment, the mean grade of improvement based on clinical assessment was 2.0 +/- 0.5 for FPS and 2.5 +/- 0.8 for CO(2) FS. On each side treated by FPS and CO(2) FS, the mean duration of post-therapy crusting and scaling was 2.3 and 7.4 days respectively and that of post-therapy erythema was 7.5 and 11.5 days respectively. The mean VAS pain score was 3.9 +/- 2.0 with the FPS and 7.0 +/- 2.0 with the CO(2) FS. CONCLUSION: We demonstrated the efficacy and safety of single-session acne scar treatment using FPS and CO(2) FS in East Asian patients. We believe that our study could be used as an essential reference when choosing laser modalities for scar treatment.

Efficacy of diode laser for treating acne keloidalis nuchae.

Acne keloidalis nuchae is usually treated with oral antibiotics, local antiseptics or intralesional steroids but with limited success. I assessed the efficacy of diode laser for treating the inflammatory and keloidal papules of acne keloidalis nuchae in two cases. The lesions in both the cases showed about 90 to 95% clearance after 4 treatment sessions at one to one and half month intervals. No new lesions were observed during the follow up period of six months after the last laser treatment. Thus, after clearing bacterial infection, laser hair epilation can be used as the first line of therapy for treating papules of acne keloidalis nuchae. This is the first attempt at treating acne keloidalis nuchae with a diode laser.