Successful Treatment of Keloid With Fractionated Carbon Dioxide (CO2) Laser and Laser-Assisted Drug Delivery of Triamcinolone Acetonide Ointment in an African-American Man
September 2017 | Volume 16 | Issue 9 | Case Report | 925 | Copyright © 2017
Ekaterina Kraeva MD,a,b Derek Ho MD,a,b and Jared Jagdeo MD MSa,b,c
aDermatology Service, Sacramento VA Medical Center, Mather, CA bDepartment of Dermatology, University of California Davis, Sacramento, CA cDepartment of Dermatology, State University of New York Downstate Medical Center, Brooklyn, NY
Keloids are fibrous growths that occur as a result of abnormal response to dermal injury. Keloids are cosmetically disfiguring and may impair function, often resulting in decreased patient quality-of-life. Treatment of keloids remains challenging, and rate of recurrence is high. We present a case of a 39-year-old African-American man (Fitzpatrick VI) with a 10-year history of keloid, who was successfully treated with eight sessions of fractionated carbon dioxide (CO2) laser immediately followed by laser-assisted drug delivery (LADD) of topical triamcinolone acetonide (TAC) ointment and review the medical literature on fractionated CO2 laser treatment of keloids. To the best of our knowledge, this is the first report of successful treatment of a keloid using combination therapy of fractionated CO2 laser and LADD with topical TAC ointment in an African-American man (Fitzpatrick VI) with excellent cosmetic results sustained at 22 months post-treatment. We believe that this combination treatment modality may be safe and efficacious for keloids in skin of color (Fitzpatrick IV-VI) and other patients. This case highlights the ability of laser surgeons to safely use fractionated CO2 lasers in patients of all skin colors.
J Drugs Dermatol. 2017;16(9):925-927.
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Keloids are fibrous growths that occur as a result of abnormal response to dermal injury, typically affecting individuals in their second and third decades of life.1 Clinically, keloids present as nodular, firm lesions that extend beyond the area of original injury and do not spontaneously regress, often continuing to grow over time.1 The prevalence is high in the skin of color population, with an estimated incidence of 5-16% of Hispanic and African-American individuals being affected.1 Although keloids are benign, they are cosmetically disfiguring and may impair function, often resulting in decreased patient quality-of-life.2 Reported symptoms of keloids may include pain, pruritus, and burning.1Treatment of keloids remains challenging, despite a variety of therapeutic options that may be available.3 Current treatment modalities include compression and silicon sheeting; pharmacotherapies using topical imiquimod, topical or intralesional steroids, intralesional bleomycin, 5-fluorouracil, interferon, and surgery.4 Treatment success rates vary; however, recurrence rates are high (estimated 50-80%) even with combination therapies.3,4There are limited published data on treatment of keloids using fractionated carbon dioxide (CO2) laser in combination with topical triamcinolone acetonide (TAC). CO2 laser emits light at wavelength of 10600 nm, which is absorbed by water and results in tissue vaporization.5 Fractionated CO2 laser creates discreet columns of ablated tissue surrounded by intact skin, known as microthermal zones (MTZs), that can assist with tissue regeneration and elicit a rapid wound healing response.6,7We present a case of an African-American man with a 10-year history of keloid, who was successfully treated with eight sessions of fractionated CO2 laser immediately followed by laser-assisted drug delivery (LADD) of topical TAC ointment and review the medical literature on fractionated CO2 laser treatment of keloids.
A 39-year-old African-American man (Fitzpatrick VI) presented to the dermatology clinic for treatment of a keloid on the posterior scalp status post-excision of acne keloidalis nuchae approximately 10 years prior. The patient complained of the aesthetically displeasing appearance of thickened skin on the posterior scalp and neck (Figure 1A). Other medical history was non-contributory.The patient underwent eight treatments of SmartXide DOT HP fractional CO2 laser (DEKA Medical Inc., San Francisco, CA) to the lateral poles and center of the keloid 6 to 8 weeks apart