Is telemedicine a useful tool to treat acne during the COVID-19 pandemic?

 Dr. Harper’s share her thoughts in this video.

The quick pivot to telemedicine caused by the COVID-19 pandemic has significantly impacted both patients and providers. In this video, Dr. Harper discusses her experience treating acne patients virtually since making the switch to telemedicine.

mental health challenges her acne patients have faced due to the pandemic

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Julie Harper, M.D., owner and president of the Dermatology and Skin Cancer Center of Birmingham in Alabama, discusses how she approaches treating acne via virtual visits after incorporating telemedicine into her practice due to the COVID-19 pandemic.

How has telemedicine impacted patient visits?

Smartphones can be used to assess acne severity using the Global Evaluation Acne (GEA) scale in darker Fitzpatrick skin types, according to a poster presented during the AAD VMX Virtual Meeting Experience 2020 July 12-14.

Acne is a very common polymorphic skin condition that can be characterized by a mosaic of signs and symptoms including comedones, papules, pustules, and nodules, which can in some cases lead to scarring. There are a number of different measures and techniques currently employed to grade the severity of acne such as simple grading techniques based on clinical examination, and lesion counting, as well as various types of photography, video microscopy, and measurement of sebum production. The GEA scale has been validated

 on photographs of acne patients and has been found to be very useful in helping clinicians to grade acne severity in their patients.

“Acne affects more than 85% of adolescents and often continues into adulthood regardless of skin color. The GEA scale largely used particularly by European health practitioners but has only been validated for face-to-face and photo evaluations for Caucasian people,” says Sophie Seité, Ph.D., La Roche-Posay Dermatological Laboratories, Levallois-Perret, France, co-author of the study.

Algorithm effectively evaluates acne severity

Dr. Seité and colleagues conducted a study to assess the suitability of the GEA scale for acne severity diagnosis on smartphone images for Black African and Asian (Chinese) ethnicities compared to Caucasians. Images from the face including right and left profiles of 1,008 acne patients (571 Caucasian, 294 Black African, and 143 Chinese) were collected in France (35 percent), South Africa (50 percent), and China (15 percent). Participants had different acne severity grades and images were taken with two smartphones equipped with IOS or Android systems where possible. Using the GEA scale, three trained dermatologists then graded each patient’s acne severity from the three images taken with both IOS and Android systems. Inter and intra-rater reproducibility was assessed using Krippendorff’s alpha and Cohen’s kappa statistical tests.

There was a substantial intra-rater reproducibility for all ethnicities and all dermatologists, the authors note. Data showed the best agreement among the three evaluators was obtained for Black African participants for IOS images and the lower agreement for Chinese participants on Android images. According to Dr. Seité, the latter outcome may be associated with the lower number of Asian participants included in the study. Researchers also found that even if both IOS and Android systems have the same camera quality, the color rendition appeared to have an influence on acne severity assessment.

Compared with the Caucasian population, acne patients of Black African and, to a lesser degree, Asian (Chinese) origins may have issues with post-inflammatory hyperpigmentation (PIHP) as well as keloid formation. According to Dr. Seité, irregular patient follow‐up, as well as poor treatment outcomes associated with a positive correlation between the duration of the disease prior to treatment and the development of scars and post-inflammatory hyperpigmentation are the main challenges for clinicians and their patients.

“It is sometimes difficult to quantify inflammatory and comedonal lesions as well as post-inflammatory hyperpigmentation in non-Caucasian patients. As such, this technology can be useful for those health practitioners with a low number of consultations with non-Caucasian patients for the evaluation of acne severity, which could assist them in choosing the best therapeutic option for their patients,” Dr. Seité said.

According to Dr. Seité, health agencies recommend both the inflammatory and non‐inflammatory acne lesion count, so a computational method, including the automatic counting of lesions, may help in regard to the short time of the consultation.

“This is a useful approach to help dermatologists and especially other healthcare practitioners in providing the best care and early management of acne patients regardless of skin color. Nevertheless,post-inflammatory hyperpigmentation evaluation is key in non-Caucasian acne patients and for dermatologists with few consultations with patients of skin color, this tool can help them make easier and quicker assessments of acne severity,” Dr. Seité says.

Dr. Seite, D Moyal, and G. Le Dantec are employees of La Roche-Posay, France.

1 Seite S, Moyal D, Abidi K, Le Dantec G, Khammari A, Dreno B. Interest in Global Evaluation Acne (GEA) Scale on Facial Photographs for Different Ethnicities – AAD poster, Denver 2020

2Dreno B, Poli F, Pawin H, Beylot C, et al. Development and Evaluation of a Global Acne Severity Scale (GEA Scale) Suitable for France and Europe. 

. 2011 Jan;25(1):43-8. doi: 10.1111/j.1468-3083.3010.03685.x.

Articles

Smartphones may provide another tool for physicians to assess acne severity in patients with darker skin types, a study shows.

Smartphones aid GEA scale assessment in patients with darker skin

Top educators in dermatology will come together to deliver CME lectures and engaging panel discussions via a premiere virtual platform during the 

 Virtual Dermatology CME Conference in September.

The virtual experience has been designed to connect attendees with experts who will provide insights into the latest in diagnostic and therapeutic strategies through master's classes, core competency workshops, and Q&A lectures.  

Topics will span basic education on skin structure and function to the latest literature-based findings and updates across subspecialty areas, including infectious disease, hair disorders,  acne and rosacea, psoriasis, pigmentation disorders, and more.

Learn more about MauiDerm Connect and register 

Top educators in dermatology will come together to deliver CME lectures and engaging panel discussions via a premiere virtual platform. Learn more about MauiDerm Connect coming September  23-27.

MauiDerm Connect will live stream in September

why acne patients shouldn’t be forgotten by providers during the COVID-19 crisis

During our conversation with Dr. Harper, she provides her take on the use of telemedicine in treating acne patients.

“The very best patients for telemedicine – at least in my opinion – are the acne patients,” she says. Learn why in the video below.

how telehealth has impacted her visits with acne patients

Is telemedicine a useful tool to treat acne during the COVID-19 pandemic? Julie Harper, M.D., owner and president of the Dermatology and Skin Cancer Center of Birmingham in Alabama, shares her insights.

Telemedicine for acne: Good or bad?

Cheryl Guttman Krader is a contributor to Dermatology Times, Ophthalmology Times, and Urology Times.

Artificial intelligence (AI) offers multiple opportunities for improving the delivery of care in dermatology, but a lack of standards for dermatologic imaging has been a major reason why the development of AI for dermatology has lagged behind the progress occurring in other medical specialties.

The International Skin Imaging Collaboration (ISIC), which was organized in 2013, is addressing this obstacle in its effort to move the field forward and bring AI into dermatology practice. At the same time, practicing dermatologists can play a valuable role in the process by becoming active participants in AI design and implementation, says Allan C. Halpern, M.D.

Dr. Halpern is chief, dermatology service, Memorial Sloan-Kettering Cancer Center, New York, N.Y., and leads ISIC.

“ISIC is an academic and industry partnership being led by Memorial Sloan-Kettering Cancer Center that is designed to facilitate the clinical application of digital skin imaging,” Dr. Halpern explains.

“It is exciting that in a short time, the work being done by ISIC has led to the development of AI algorithms for image-based diagnosis that are able to outperform most dermatologists. But there is still a lot that needs to be done, and dermatologists can be important contributors to the ongoing evolution as we aim to promote the application of AI and make it as clinically useful as possible.”

Although imaging of skin lesions would seem to be a “no brainer,” for a variety of reasons it is not something that has been routinely done in clinical practice. The situation has been changing, however, driven in part by patient demand for access to services and being particularly accelerated by the wider adoption of telemedicine as a means for delivering care during the COVID-19 pandemic.

ISIC was created based on recognition that in order to provide reliable information, AI algorithms need to be trained with good data. In terms of algorithms for image-based diagnosis, that means having a large set of quality images that are representative of the entire population and accurately annotated.
To address the existing gap in this area, ISIC set out to lay the groundwork for applying the Digital Imaging and Communication in Medicine (DICOM) metadata model to dermatology imaging.

“Without standards, images in dermatology will continue to find their way into electronic medical records without any quality assurance or systematic way for sharing,” Dr. Halpern says.

“DICOM standards provide both a quality check and interoperability.”

Thus far, a dermatology DICOM Working Group has developed consensus standards around techniques, technology, and terminology used for dermatologic imaging. The group has published multiple consensus standards pertaining to terminology that relate to clinical diagnosis, dermoscopic features, anatomic site, and more.

ISIC is also building a public archive of clinical and dermoscopic images that can be used to train AI algorithms, and it has engaged the computer science community in algorithm development by holding annual lesion analysis challenges. Over the years, the challenges have become more and more complex as they have featured a growing number of images that are associated with more data and representing an increasing number of diagnoses. The challenges have also garnered the participation of a growing number of machine-learning lab teams, Dr. Halpern said.

Each challenge is hosted in partnership with a different imaging organization. The 2020 event, which took place in May 2020, was held in conjunction with the Society for Imaging Informatics in Medicine (SIIM), which is the premier professional organization for medical imaging. The challenge represented the first large scale interaction of dermatology AI with the rest of the medical computer imaging world, and for the first time, it used images with a DICOM wrapper, Dr. Halpern says.

“To date there have been hundreds of technical papers published from the annual challenges, and they are having a significant impact on developing new approaches to AI algorithms for dermatology,” he adds.

As it works towards optimizing the benefits of AI algorithms to support clinicians, ISIC is also investigating how the utility of the output is affected by the way it is presented. This question was explored in a recent study reported in 

As Dr. Halpern and his ISIC colleagues continue working towards achieving their goals, they are looking to engage clinician cooperation.

“I invite anyone who has a large collection of images with accurate associated information to contribute the dataset to ISIC and participate as part of our organizing committee. In addition, there are increasing opportunities through ISIC for dermatologists to participate in studies that can help us understand the best ways to share AI insights with practicing clinicians,” he said.

In seeking to enlist help from the dermatology community in contributing toward AI design, testing, and implementation, Dr. Halpern emphasized that the benefits of AI in medicine are the product of a human-computer collaboration.

“AI has the potential to augment clinicians’ diagnostic capability and can bring multiple additional benefits. Dermatologists should not feel threatened by AI because it is not going to replace physicians,” he says.

 Human–computer collaboration for skin cancer recognition. 

The International Skin Imaging Collaboration is an academic and industry partnership designed to facilitate the clinical application of digital skin imaging, with an initial focus on melanoma.
The group is developing standards for dermatologic imaging and building a public archive of clinical and dermoscopic images for use in developing artificial intelligence diagnostic algorithms.


Collaboration makes progresses standards for implementing AI

Knowledge of the inflammatory pathways that are operative in rosacea and the putative mechanisms of action of existing modalities indicated for treating inflammation-related signs and symptoms of rosacea provides a basis for understanding the limitations of current treatments and identifying potential targets for achieving better outcomes, says Jerry Tan, M.D., adjunct professor of internal medicine and dermatology, Western University, London, Ontario, Canada.

In a recently published article, Dr. Tan, together with J. Mark Jackson, M.D., clinical professor of dermatology, University of Louisville, Louisville, Ky., undertook a review of the complex inflammatory processes of rosacea and the spectrum of topical and systemic agents used as anti-inflammatory treatment with a focus on the potential mechanisms of each therapy.

“Our hope in doing so was to understand current gaps and identify opportunities for interventions that might better help patients with the various presenting features of rosacea,” Dr. Tan tells 

“From our review, we concluded that there are no regimens available that confer long-term relief of erythema, remission of papules and pustules in large proportions of those affected, or reduced risk of progression to phymatous changes. These limitations indicate an unmet need for more efficacious treatments that can address the inflammation that gives rise to most signs and symptoms of rosacea and that will offer patients the possibility of complete clearance.”

Discussing the pathophysiology of rosacea, Drs. Tan and Jackson note that prior research has identified four converging inflammatory pathways: 1) activation of innate immunity via toll-like receptor 2 (TLR2); 2) protein activated receptor 2 (PAR2); 3) inflammasome activation; and 4) transient receptor potential (TRP) channels. These pathways are described in more detail in the body of the article and outlined graphically.

The latter figure identifies the common exogenous and endogenous triggers for each of the contributory inflammatory pathways. In addition, it summarizes their signal transduction pathways, including the cellular and molecular participants, illustrates how they translate into various pathological features of rosacea (ie., vasodilation, angiogenesis, inflammation/neurogenic inflammation, fibrosis), and shows the downstream phenotypic signs and symptoms of rosacea (ie., erythema/persistent erythema, flushing, telangiectasia, papules/pustules, phymata, heat sensation, edema) that are associated with the various pathologies. The figure also identifies the therapies that have mechanisms of action specific to each pathway.

Dr. Tan points out that erythema developing as a consequence of vasodilation or angiogenesis is a feature of rosacea that is common to the activation of all four pathways.However, specific pathway activation may lead to specific presentations, suggesting the possibility of personalizing treatment selection if clinical features or biomarkers can be identified that indicate which pathways are dominant in the individual

“As an example, activation of the TRP channels leads to transient and fixed erythema, but it does not lead to the development of papules/pustules. Presence of the latter inflammatory lesions may be more representative of activation of the TLR2, PAR2, and inflammasome pathways,” he explains.

As mentioned in the article, there may also be crosstalk between the four pathways that can perpetuate a loop of inflammatory responses and progression of the phenotypic features of rosacea in some patients.

The section on anti-inflammatory treatments for rosacea summarizes information for both products that have regulatory agency approval for use in rosacea and for commercially available modalities that are used off-label. Included in the discussion are efficacy results from clinical trials, available data from preclinical and clinical studies relating to effects on inflammatory mediators, and efficacy results from clinical trials investigating combination regimens using oral subantimicrobial doxycycline and various topical agents.

In addition, the article provides a brief overview of emerging treatments. The latter include topical minocycline foam, which was recently approved by the FDA, and several that are in clinical trials, including encapsulated 5% benzoyl peroxide cream; topical antimicrobial peptide gel (Omiganan); the proteasome inhibitor ACCU-D1; extended release, low-dose oral minocycline (DFD-29); rifaximin; a topical formulation of beneficial ammonia oxidizing bacteria (B244); and the human interleukin-17A antagonist secukinumab.

Offering their perspectives on future needs in the treatment of rosacea, Drs. Tan and Jackson identify the importance of long-term studies that can provide insights on predictive factors for risk of developing inflammatory lesions and/or phyma and whether early intervention for erythema mitigates progression. They also highlight the limitations of existing treatments and describe some features of “ideal” therapies that address the underlying inflammatory pathways of rosacea while avoiding unwanted side effects.

Dr. Tan and Dr. Jackson have been an advisor, consultant, investigator, and/or speaker for companies that market treatments for rosacea.

Experts offer insights into the inflammatory pathways involved in rosacea pathogenesis, the putative anti-inflammatory mechanisms of action of treatments for rosacea, and future therapeutic needs.

Pathophysiologic pathways provide treatment efficacy insight

a weekly glimpse into what your patients may be reading in the media about skin health.

explains why your skin might be currently having an unusual reaction to makeup and reveals an editor’s experience with at-home dermaplaning. 

writes about hand sanitizer-induced eczema and the rise of “anti-stress” skincare. Meanwhile, 

dives into the question: If fragrance in skincare is truly bad or not? Finally, 

sets the record straight on sun protection myths.

Experiencing Eczema Due to Hand Sanitizer? Here’s What to Do

Why Your Skin May Be Reacting Poorly to Makeup Right Now

Is “Anti-Stress” Skin Care the Beauty Salve for Our Times?

An Allure Editor's Experience With At-Home Dermaplaning

SPF and Sun Protection Myths to Stop Believing, Stat

This week’s edition of The Mainstream Patient features stories about sun protection myths, hand sanitizer-induced eczema, at-home dermaplaning, anti-stress skincare, plus more.

The Mainstream Patient: August 10

“I think it’s going to have an impact,” says Dr. Harper. Hear her reasons in the video interview below.

Don’t forget acne patients during COVID-19

Patient education easier via virtual visits

Will the current practice of using telemedicine for acne care have an impact on the future of dermatology? We spoke with Julie Harper, M.D., owner and president of the Dermatology and Skin Cancer Center of Birmingham in Alabama, on the topic.

Will telemedicine impact the future of acne care?

Patients with rosacea using a set of skincare products formulated for sensitive and redness-prone skin benefited with improvements in disease-related signs and symptoms as well as quality of life, reported researchers in a study published online in the 

The skincare regime was comprised of three commercially available products (LETISR sensitive and red skin), including micellar water for cleansing in the morning and evening, a broad-spectrum (UVA/UVB) SPF20 cream, and night serum.

At the end of the eight-week, prospective, randomized study, patients using the specialized skincare products experienced greater relief of rosacea symptoms, reduction of objectively measured erythema, and improvement in the Dermatology Life Quality Index (DLQI) score compared with controls who continued to use their previous skincare products.

 Pilot study examines facial microbiome diversity

The investigators observed that the findings are strengthened by the prospective controlled design of their study and its use of an objective method to quantitate facial erythema. Commenting further, they state “With countless available skincare products, 

 studies with objective evaluation methods are necessary in order to prove their efficacy.”

The study was conducted by members of the Department of Dermatology and Allergy, University Hospital Munich, Munich, Germany, and enrolled 60 Caucasian patients (44 women, 16 men) with rosacea who had persistent centrofacial erythema. Eligible patients were required to have received no treatment for the redness within the past three months.

The participants were randomized 5:1 to the intervention and control groups. Patients in the intervention group received precise instructions on the use of the study products. All patients were told to avoid excessive sun exposure and use of other rosacea treatments.

Safety and efficacy data were collected at four and eight weeks after the baseline visit. Facial erythema was evaluated as the primary endpoint and was determined by analysis of the intensity of the color red at five defined points per cheek on images obtained with a three-dimensional imaging device (VECTRA, Canfield Scientific). The investigator performing the measurements was blinded to the patients’ study group assignment.

Patients also completed both the DLQI and a symptom questionnaire at baseline and each follow-up. The symptom questionnaire assessed the presence of itching, tension, warmth, burning, and dryness.

Of the 60 enrolled patients, 44 (73%) completed the eight-week study. Thirteen of the 16 patients who did not complete the study were lost to follow-up and all were in the intervention group. Two patients in the intervention group withdrew early due to mild worsening of facial redness and pustules accompanied by a burning sensation. Treatment adherence in the intervention group, which was determined by weighing the returned skincare products at study completion, was considered to be good.

The analyses of facial erythema showed a statistically significant improvement after just four weeks in both study groups. However, only the intervention group had a statistically significant further improvement over the next four weeks. At study completion, facial erythema was reduced from baseline by 16% in the intervention group and 8% in the control group. The investigators commented that the continuous improvement observed in the intervention group might indicate the superior efficacy of the study products.

Overall, the patients participating in the study had mild symptoms at baseline. The mean total symptom score in the intervention group improved by 28.6% after four weeks and by 57.1% after eight weeks. Both changes were statistically significant, and at eight weeks, it was noted that symptoms in the intervention group were nearly fully diminished. There was no change from baseline in mean total symptom score in the control group at either follow-up visit.

Mean baseline DLQI scores were 3.3 in the intervention group and 2.1 in the control group, indicating that the patients in the study had a relatively high overall quality of life. Nevertheless, statistically significant reductions in DLQI score (indicating improvement) were achieved in the intervention group at both 4 weeks (-51.5%) and 8 weeks (-54.5%), and the change was attributed to improvement in clinical appearance. Relative to baseline, the mean DLQI score in the control group decreased by 4.8% at 4 weeks and by 23.8% at eight weeks, but neither change was statistically significant.

The two patients in the intervention group who withdrew from the study because of side effects experienced slight aggravation of erythema and pustules along with burning. The patients declined patch testing to investigate the cause, and so the investigators stated that an association with use of the skincare products could not be established.

The study was funded by the manufacturer of the skincare products used in the intervention group. One of the authors disclosed receiving fees as a speaker and advisor to LETI Pharma and other companies that market pharmaceuticals and cosmeceuticals for rosacea.

1 Guertler A, Jøntvedt NM, Clanner-engelshofen BM, Cappello C, Sager A, Reinholz M. Efficacy and safety results of micellar water, cream and serum for rosacea in comparison to a control group. 

Effects of a specialized skincare regimen for sensitive and redness-prone skin were investigated in an eight-week, prospective, controlled clinical trial enrolling 60 patients with rosacea. The intervention was associated with improvements in objectively measured erythema, rosacea symptoms, and health-related quality of life.

Specialized skincare regimen improves rosacea symptoms 

 Dr. Harper shares her experience in this video.

Today, Dr. Harper highlights the importance of educating patients about their acne medications during virtual visits.

 Dr. Harper emphasizes the importance of 

ensuring acne treatment during the pandemic

potential benefits of using telemedicine to treat acne patients

 Will telemedicine impact the future of acne care?

Virtual visits may allow providers to focus more on patient education, says Julie Harper, M.D., owner and president of the Dermatology and Skin Cancer Center of Birmingham in Alabama.

AbbVie is hoping to spread awareness of hidradenitis suppurativa (HS) with the launch of their new educational website tailored for physicians.

By gathering feedback from various advocacy and professional organizations, the company has created a website to provide physicians with the best resources to better identify, diagnose, manage and treat HS.

The website provides a variety of HS resources that physicians can use, including patient case studies, links to organizations advancing HS education, treatment and management information, links to HS support, a differential diagnosis quiz and an overview of causes of HS and disease progression.

HS Disease Education site has officially launched! 

HS Source: hidradenitis suppurativa clinical resource

Research gains traction for hidradenitis suppurativa

Clinical trials offer hope for hidradenitis suppurativa patients

AbbVie announces the launch of their hidradenitis suppurativa-centered educational website aimed at bringing awareness and educating physicians on the disease.  

AbbVie launches hidradenitis suppurativa education center for physicians

Although there is no wide consensus as to which combination therapies work best for keloid lesions, many specialists around the world are independently using and experimenting with combinations of older and newer treatment modalities, many of which are proving to be very effective, an expert says.

“Keloids are challenging to treat and as such, many clinicians will typically combine a number of different treatments and delivery modalities in order to help achieve optimal clinical outcomes. However, currently, there is no agreement as to which are the most effective combination treatments for keloids and which combination therapy might work better for keloids of a different anatomical location,” says David M. Ozog, M.D., FAAD, chair, department of dermatology, C.S. Livingood Chair in Dermatology, director of cosmetic dermatology, division of Mohs and dermatological surgery, Henry Ford Hospital, Detroit.

The treatment of keloids has always been complex and includes a wide spectrum of therapies ranging from more traditional surgical procedures to intralesional or topical agents, radiation, botulinum toxin and energy-based devices. Though many of these therapies can work well in keloid treatment as stand-alone therapies, it is the clever combinations of these treatment approaches and how they are optimally delivered that has been somewhat revolutionary in keloid therapy of late, Dr. Ozog says.

Genetics may play role in keloid formation

In his keloid patients, Dr. Ozog usually treats the lesion with either a combination of pulsed dye laser (injection) or fractional ablative laser (topical) prior to the application corticosteroids or 5-fluorouracil (5-FU), allowing the medication to reach much deeper and more consistently into the keloid.

In recalcitrant lesions, Dr. Ozog may perform a traditional surgical excision followed by the application of varying combination therapies including laser, the injection of steroids and/or 5-FU, and/or radiation treatment to the target area.

For painful keloids and particularly those located on the trunk, Dr. Ozog found that pretreating these lesions with pulsed dye or CO2 laser enables a quicker and more efficient delivery of steroid or 5-FU drugs due to the tissue edema created.

Other leading specialists around the world are also currently using similar combination treatments, Dr. Ozog says, and achieving similar positive clinical outcomes. Matteo Clementoni, M.D., Milan, Italy, has achieved remarkable clinical results using a CO2 laser followed by a combination of botulinum toxin, steroids, and 5-FU applied topically on the skin, Dr. Ozog says. The delivery of the topical drugs to the keloid is far more effective and quicker through the micro-channels created by the CO2 laser, he says.

“The positive response to these new and experimental keloid therapies independently performed by specialists around the world is testament to their efficacy and reinforces their place in keloid therapy,” Dr. Ozog says.

Another interesting treatment approach pioneered by Somesh Gupta, M.D., New Delhi, India, combines RF energy with the delivery of steroids and 5-FU at the same time.1 According to Dr. Ozog, the novel treatment using insulated probes protects the outer keloidal skin from the heat produced by the RF device, helping to prevent any unwanted pigmentary changes, and allows the clinician to deliver the RF waves to the core of the lesion while simultaneously incrementally delivering the drugs chosen for treatment.

“For ear keloids, surgery followed by some other treatment such as steroids or 5-FU is still commonly employed. However, for truncal lesions where recurrence rates are high, there is a definite trend towards combination approaches that incorporate energy-based modalities such as laser and RF,” Dr. Ozog says.

One of the newer developments in keloid research revealed in a recent study2 by Ardeshir Bayat, M.D., from the University of Manchester, UK, was that hypertrophic scars and keloidal scars are very different and that there are specific biomarkers that can help clinicians differentiate between them.

According to Dr. Ozog, there are distinct molecular differences between keloids of different anatomical locations and these lesions behave differently in the same patient depending on the location they occur.

“Many specialists from all around the world are currently using combinations of energy-based devices and medications whether they are cytotoxic, steroids, or even botulinum toxin. New and exciting combinations of treatments combined with clever drug delivery modalities is what is making the difference and allowing us to achieve exceptional clinical outcomes,” Dr. Ozog says.

Dr. Ozog reports no relevant disclosures.

1 Yadav S, Gupta S. A simple device for ablation of keloidal tissue and serial deposition of intralesional drugs. J Am Acad Dermatol. 2018 May;78(5):e107-e109.

2 Bagabir RA, Syed F, Sheniere P, Paus R, Bayat A. Identification of a potential molecular diagnostic biomarker in keloid disease: syndecan-1(CD138) is overexpressed in keloid scar tissue. J Invest Dermatol. 2016 Nov;136(11):2319-2323.

Combination therapies that integrate older therapies have shown great promise in the treatment and management of keloids.