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 .

Extirpación quirúrgica con cierre primario y uso de Isotretinoína en acné queloídeo de la nuca: serie de 6 casos clínicos / Acne keloidalis nuchae

El Acné queloídeo de la nuca se presenta principalmente en hombres jóvenes de raza negra; su etiología es desconocida, pero se piensa que sería multifactorial. El cuadro clínico corresponde a pápulas y pústulas que tienden a confluir en placas de aspecto queloídeo y que se observan como alopecia cicatricial, produciendo gran repercusión tanto física como psicológica en el paciente. Histológicamente se distingue una etapa temprana y una avanzada. No existe tratamiento curativo para este cuadro, pero se ha experimentado con múltiples opciones de tratamiento. En este trabajo se exponen los resultados de nuestra experiencia terapéutica con cirugía excisional asociada a cierre primario y posterior uso de Isotretinoína oral.

The Acne keloidalis nuchae occurs mainly in young black men; its etiology is unknown but is thought to be multifactorial. Clinically it presents as papules and pustules which tend to coalesce in keloid-like plaques and they are observed as scarring alopecia, producing great impact both physically and psychologically in the patient. An early and an advanced stage can be distinguished with histological techniques. There is no cure for this pathology, even though multiple treatments have been tried. In this paper, we expose the results of our therapeutic experience with excisional surgery associated with primary closure and subsequent use of oral Isotretinoin.

The efficacy of laser-assisted hair removal in the treatment of acne keloidalis nuchae; a pilot study.

BACKGROUND: Laser-assisted hair removal causes miniaturization of hair shafts which are the principal contributors to inflammation in acne keloidalis nuchae (AKN). OBJECTIVE: To assess the efficacy of hair reduction by long pulsed Nd-YAG laser as a therapeutic modality for AKN. METHODS: This interventional pilot trial included 16 patients with AKN who received 5 sessions of long pulsed Nd-YAG laser. Lesions were objectively and subjectively assessed at the third and fifth laser sessions, and 1 year after. Global response to treatment was rated using a quartile grading scale regarding the percentage improvement in the count of papules and the size of the plaques. Biopsies were taken before and 2 weeks after the fifth session to evaluate the pathological changes associated with improvement of the treated lesions. RESULTS: All patients showed a significant improvement. The percentage of improvement in the early caseswas significantly higher when compared to late cases.Two weeks after the fifth session, all biopsies showed a significant decrease in the inflammatory infiltrate except one case. Sclerosis was markedly decreased. Complete absence of hair follicles and adenexawas observed, apart from in 2 cases. CONCLUSION: Laser hair depilation can significantly improve this disfiguring chronic disorder. Starting treatment as early as possible achieves the best results and can stop the disease process if followed by maintenance sessions.

Treatment of acne scarring.

Acne scarring is a common and expected result of moderate to severe acne vulgaris. Given the clinical variety of acne scars and the plethora of treatment options available, management of cutaneous scarring from acne can be challenging and confusing. This article discusses the pathophysiology of acne and acne scarring to better understand its biologic and structural nature. A simple, yet practical classification schema is presented, allowing caregivers to better organize their assessment of acne scarring and develop useful management strategies from this model. This article highlights the various useful laser options that are available for the treatment of acne scarring.

[Clinical efficacy of acne scar treatment with micro-plasma radio frequency].

OBJECTIVE: To explore the efficacy of facial acne scars treatment with micro-plasma radio frequency. METHODS: A total of 24 patients with facial acne scars underwent micro-plasma treatment for 3 - 5 times. And their efficacies were evaluated by the patient photographs before and 2 months after treatment. RESULTS: Facial acne scars were characterized by clouds of pitted scars with no specific shape. No difference appears in susceptibility between males and females. The overall improvement rate was 83.33%. The degree of improvement was as follows: significant 33.33%, moderate 25%, mild 25% and poor 16.67%. CONCLUSION: Micro-plasma technique is an effective therapy for acne scar.

Dermabrasion for acne scars during treatment with oral isotretinoin.

BACKGROUND: Oral isotretinoin is the criterion standard treatment for severe inflammatory acne associated with scar development. Atypical or exaggerated cicatrization related to oral isotretinoin was reported throughout the 1980s and 1990s. Dermabrasion for atrophic acne scar revision is not recommended 6 to 12 months from the end of oral isotretinoin treatment. OBJECTIVE: To evaluate wound healing after localized dermabrasion in patients receiving oral isotretinoin. MATERIALS & METHODS: Interventional, prospective study involving seven patients taking oral isotretinoin to treat acne and with atrophic acne scars on the face. Manual dermabrasion was performed on all patients in an area of approximately 1 cm(2), and a 6-month reepithelization follow-up by clinical evaluation was conducted. RESULTS: All patients presented normal cicatrization evolution; hypertrophic scarring or keloid as a result of localized abrasion was not observed, and atrophic acne scar revision result was excellent. CONCLUSION: The current recommendation to wait 6 to 12 months after treatment with oral isotretinoin for acne scar revision using dermabrasion should be re-evaluated. Abrasion of a small test area may be a useful predictor of wound healing, enabling earlier acne scar treatment using this procedure.

Hypertrophic scarring of the neck following ablative fractional carbon dioxide laser resurfacing.

BACKGROUND: Ablative fractional carbon dioxide (CO(2)) laser treatments have gained popularity due to their efficacy, shortened downtime, and decreased potential for scarring in comparison to traditional ablative CO(2) resurfacing. To date, scarring with fractional CO(2) lasers has not been reported. OBJECTIVE: Five patients treated with the same fractional CO(2) laser technology for photodamage of the neck were referred to our practices 1-3 months after treatment. Each patient developed scarring. Of the five cases, two are discussed in detail. The first was treated under general anesthesia on the face and anterior neck at a pulse energy of 30 mJ (859 microm depth) with 25% coverage. Eleven days after treatment, three non-healing areas along the horizontal skin folds of the anterior neck were noted. At 2 weeks after CO(2) ablative fractional resurfacing, these areas had become thickened. These raised areas were treated with a non-ablative fractionated 1,550 nm laser to modify the wound healing milieu. One week later, distinct firm pale papules in linear arrays with mild hypopigmentation had developed along involved neck skin folds. Skin biopsy was performed. For the second patient, the neck was treated at a pulse energy of 20 mJ (630 microm depth) with 30% coverage of the exposed skin, with a total treatment energy of 5.0 kJ. Minimal crusting was noted on the neck throughout the initial healing phase of 2 weeks. She then experienced tightness on her neck. Approximately 3 weeks after treatment, she developed multiple vertical and horizontal hypertrophic scars (HS). RESULTS: Histopathology for the first case confirmed the presence of a hypertrophic scar. The papules in this case completely resolved with mild residual hypopigmentation after treatment with topical corticosteroids. HS failed to resolve in the second case to date after 1 month. CONCLUSION: As with traditional ablative CO(2) laser resurfacing, HS is a potential complication of ablative fractional CO(2) laser resurfacing, particularly on the neck. With early diagnosis and appropriate treatment HS of neck skin may be reversible. We urge caution when treating the neck with this device and close attention to wound care in the post-operative period.

Surgical excision of acne keloidalis nuchae with secondary intention healing.

Acne keloidalis nuchae (AKN) is a chronic scarring folliculitis that presents clinically as follicular papules and pustules. These can coalesce into firm hypertrophic plaques and nodules on the nape of the neck, most commonly affecting young adult men. Treatment includes topical steroids/antibiotics and oral antibiotics, but often has disappointing results. Surgical approaches include excision with primary closure or skin grafting, and hair-removal lasers. Another surgical approach is excision with secondary intention healing. This can result in good cosmesis with little or no recurrence. We report two men with AKN where treatment by excision with secondary intention was successful.

Acne keloidalis in females: case report and review of literature.

Acne keloidalis, also known as folliculitis nuchae, is a form of chronic scarring folliculitis characterized by fibrotic papules and nodules of the nape of the neck and the occiput. It particularly affects men of African descent and is rarely ever seen in women. We here report the clinical findings of two Nigerian women who developed acne keloidalis. This report also reviews the pathogenesis of this disease.