WBR0843

Author	[[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Yazan Daaboul, M.D.)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pathology
Sub Category	SubCategory::Dermatology
Prompt	[[Prompt::A 28-year-old man presents to the dermatology clinic with a lesion on his right hand. Upon further questioning, he informs the physician that he sustained a burn to the dorsum of his hand at the site of the lesion one year ago. On physical examination, the physician notes a raised lesion shown in the image below. Which of the following is an appropriate treatment option for this patient's condition? ]]
Answer A	AnswerA::Intralesional corticosteroids
Answer A Explanation	AnswerAExp::Intralesional corticosteroids are first line therapeutic options for the treatment of hypertrophic scars or keloids.
Answer B	AnswerB::Systemic corticosteroids
Answer B Explanation	AnswerBExp::Systemic corticosteroids are not helpful for the treatment of hypertrophic scars or keloids.
Answer C	AnswerC::Topical corticosteroids
Answer C Explanation	AnswerCExp::Topical corticosteroids are not helpful for the treatment of hypertrophic scars or keloids.
Answer D	AnswerD::Systemic antibiotics
Answer D Explanation	AnswerDExp::Antibiotics are not helpful for the treatment of hypertrophic scars or keloids.
Answer E	AnswerE::Systemic chemotherapy
Answer E Explanation	AnswerEExp::Intralesional chemotherapy is effective for the treatment of hypertrophic scars or keloids. In contrast, systemic chemotherapy is not a therapeutic option for hypertrophic scars or keloids
Right Answer	RightAnswer::A
Explanation	[[Explanation::The patient is presenting with a hypertrophic scar. Hypertrophic scars and keloids are characterized by the high rates of recurrence following excision by surgery. Treatment options for hypertrophic scars and keloids are numerous with varying rates of success. Intralesional corticosteroids are considered the mainstay of therapy for hypertrophic scars and keloids. Other first line options include silicone sheeting and pressure dressingss, whereas ptients with smaller lesions may benefit from cryotherapy. Surgical resection is reserved for large scars that are unlikely to improve with any first line treatment option. However, surgical excision alone exacerbates a keloid. Thus, surgery must be combined with other treatment modalities, such as radiotherapy, pulsed dye lasers, or imiquimod creams. Novel therapies are currently emerging for the treatment of established hypertrophic scars and keloids, including intalesional calcium channel blockers, such as verapamil, and chemotherapeutic agents, such as fluorouracil and bleomycin injections. Educational Objective: Intralesional corticosteroids are helpful as first line agents for treatment of hypertrophic scars or keloids References: Juckett G, Hartmann-Adams H. Management of keloids and hypertrophic scars. Am Fam Physicians. 2009;80(3):253-260. First Aid 2014 page 225]]
Approved	Approved::No
Keyword	WBRKeyword::Hypertrophic scar, WBRKeyword::Keloid, WBRKeyword::Scar, WBRKeyword::Intralesional corticosteroids, WBRKeyword::Corticosteroids, WBRKeyword::Steroids, WBRKeyword::Treatment, WBRKeyword::Burn
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Order in Linked Questions	LinkedOrder::