WBR0843

Author	[[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pathology
Sub Category	SubCategory::Dermatology
Prompt	[[Prompt::A 28 year old male patient presents to the dermatology clinic with a lesion on his right hand. Upon further questioning, the informs the physician that he had burnt 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? ]]
Answer A	AnswerA::Intralesional corticosteroids
Answer A Explanation	AnswerAExp::Intralesional corticosteroids are considered first line therapy for the treatment of keloid scars.
Answer B	AnswerB::Systemic corticosteroids
Answer B Explanation	AnswerBExp::Systemic corticosteroids are not helpful for the treatment of keloid scars.
Answer C	AnswerC::Topical corticosteroids
Answer C Explanation	AnswerCExp::Topical corticosteroids are not helpful for the treatment of keloid scars.
Answer D	AnswerD::Systemic antibiotics
Answer D Explanation	AnswerDExp::Antibiotics are not helpful for the treatment of keloid scars.
Answer E	AnswerE::Systemic chemotherapy
Answer E Explanation	AnswerEExp::Intralesional chemotherapy has been shown to be effective for the treatment of keloid scars, but not systemic chemotherapy.
Right Answer	RightAnswer::A
Explanation	[[Explanation::The patient is presenting with a keloid scar. Hypertrophic scars and keloids are characterized by the high rates of recurrence following excision by surgery. Treatment options for keloids are many, with varying rates of success. Intralesional corticosteroids are considered the mainstay of therapy for hypertrophic keloid scars. Other first line options include silicone sheeting and pressure dressings.s Patients with smaller lesions may benefit from cryotherapy. Surgical resection is reserved for large scars that are unlikely to improve using any first line option. However, surgical excision alone exacerbates the keloid scar. Thus, surgery must be combined with other modalities, such as radiotherapy, pulsed dye lasers, or even imiquimod creams. New therapies are currently emerging for the treatment of established keloid scars, 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 keloid scars. Reference: Juckett G, Hartmann-Adams H. Management of keloids and hypertrophic scars. Am Fam Physicians. 2009; 80(3):253-260. Educational Objective: References: ]]
Approved	Approved::No
Keyword	WBRKeyword::keloid, WBRKeyword::scar, WBRKeyword::hypertrophic, WBRKeyword::hypertrophy, WBRKeyword::intralesional, WBRKeyword::corticosteroid, WBRKeyword::steroid, WBRKeyword::steroids, WBRKeyword::corticosteroids, WBRKeyword::treatment
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Order in Linked Questions	LinkedOrder::