WBR0843

Author	[[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Yazan Daaboul, M.D.)]]
Exam Type	USMLE Step 1
Main Category	Pathology
Sub Category	Dermatology
Prompt	[[Prompt::A 28-year-old man presents to the dermatology clinic with a lesion on his left forearm. Upon further questioning, he informs the physician that he sustained 2 burns in his left forearm 1 year ago; and the current lesions developed at the sites of the previous burn wounds. On physical examination, the physician notes 2 raised pink lesions along the left forearm as shown in the image below. Which of the following is an appropriate therapeutic option for this patient's condition? ]]
Answer A	Simple excision
Answer A Explanation	Simple excision alone is often considered a first line therapeutic option for patients with hypertrophic scar, but not keloids.
Answer B	Systemic corticosteroids
Answer B Explanation	Systemic corticosteroids are not helpful for the treatment of hypertrophic scars or keloids.
Answer C	Topical corticosteroids
Answer C Explanation	Topical corticosteroids are not helpful for the treatment of hypertrophic scars or keloids.
Answer D	Neoadjuvant radiotherapy
Answer D Explanation	Hypertrophic scars do not usually require radiotherapy. For keloids, neither neoadjuvant (before surgery) radiotherapy nor radiotherapy alone is a good therapeutic option. Instead, adjuvant radiotherapy (following intramarginal excision) is often useful.
Answer E	Systemic chemotherapy
Answer E Explanation	Intralesional chemotherapy may be 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	A
Explanation	[[Explanation::The patient is presenting with a hypertrophic scar. While intralesional corticosteroids are treatment options for both hypertrophic scars and keloids, simple excision alone is often considered a first line therapeutic option for patients with hypertrophic scar, but not keloids. The following table compares hypertrophic scars with keloids and demonstrates the optimal therapeutic options for both lesions. Educational Objective: Simple excision alone is often considered a first line therapeutic option for patients with hypertrophic scar, but not keloids. References: Wolfram D, Tzankov A, Pülzl P, et al. Hypertrophic scars and keloids - a review of their pathophysiology, risk factors, and therapeutic management. Dermatol Surg. 2009;35(2):171-81. Juckett G, Hartmann-Adams H. Management of keloids and hypertrophic scars. Am Fam Physicians. 2009;80(3):253-260. Image: "Hypertrophic scar -4 months after incident- 2013-04-05 00-46.jpg" by user:Cgomez447, licensed under Creative Commons Attribution-Share Alike 3.0 Unported license. http://commons.wikimedia.org/ retrieved 1-Jan-2015. First Aid 2014 page 225]]
Approved	No
Keyword	Hypertrophic scar, Keloid, Scar, Intralesional corticosteroids, Corticosteroids, Steroids, Treatment, Burn
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