2026 Clinician Corner - Keloid remodeling: improved outcomes with fractional CO₂ laser plus intralesional triamcinolone in a Fitzpatrick IV patient

Abstract 

Keloid scarring is more prevalent in individuals with pigmented skin and can be particularly challenging to treat due to the risk of dyspigmentation and limited response to first-line therapies. This case describes a Fitzpatrick type IV patient whose keloid remodeling plateaued with intralesional corticosteroids but improved significantly following adjunctive fractional CO₂ laser therapy. The report highlights the safe use of lasers in darker skin types and reinforces the need to expand equitable access to such treatment modalities. 

Keywords:  Fitzpatrick type IV, fractional CO₂ laser, keloid, laser therapy, postinflammatory hyperpigmentation 

Please click here to read the article
Please click here to subscribe to BUMC Proceedings

Faculty credentials/disclosure 

The planners and faculty for this activity have no relevant financial relationships to disclose. The patient consented to the publication of this report.

Process

Click the "add to cart/begin" button, pay any relevant fee, take the quiz, complete the evaluation, and claim your CME credit.  You must achieve 100% on the quiz with unlimited attempts available.

  • By completing this process, you are attesting that you have read the journal article.

Expiration date:

Credit eligibility for this article is set to expire on March 1, 2027.

Learning Objectives

After completing the article, the learner should be able to:

  • Describe the role of intralesional corticosteroids and fractional CO2 laser therapy in the management of keloid scars, particularly in patients with skin of color. 

  • Identify strategies to minimize the risk of postinflammatory hyperpigmentation complications when using fractional CO2 laser therapy in patients with skin of color. 

Key Points 

  • Keloids are more prevalent and treatment resistant in patients with skin of color. 

  • Disparities in laser access for skin of color populations may reflect cost barriers, training gaps, and limited representation in clinical trials. 

  • Concerns about postinflammatory hyperpigmentation should be weighed against clinical benefit. 

  • Fractional CO₂ laser therapy, when used conservatively, can safely improve keloid appearance and symptoms in Fitzpatrick IV–VI skin. 

You may also be interested in

2026 Clinician Corner - A rare case of TCF3-related agammaglobulinemia in a child with recurrent Haemophilus influenzae bacteremia
We report a case of a previously healthy 4-year-old girl who presented with two recurrent episodes of complicated pneumonia and Haemophilus influenzae bacteremia. Immunologic evaluation revealed hypogammaglobulinemia, as immunoglobulins (IgG, IgA, IgM, IgE) were below detectable levels and genetic testing identified a pathogenic TCF3 variant, confirming a diagnosis of TCF3 (transcription factor 3) deficiency. TCF3 is a key transcription factor in B- and T-cell development, and its deficiency results in impaired antibody production and increased susceptibility to infections. This case highlights the rarity of TCF3 mutations in pediatric patients, the importance of early recognition, and the critical role of immunoglobulin replacement therapy as the current mainstay of treatment.
2026 Clinician Corner - Heterotaxy syndrome: a rare risk factor for a pulmonary embolism in a young person
Heterotaxy syndrome, or situs ambiguus, is a rare congenital condition characterized by abnormal left-right positioning of thoracoabdominal organs. It often includes splenic anomalies such as polysplenia and vascular malformations like interruption of the inferior vena cava (IVC) with azygos continuation. These anatomical variants can impair venous return, increasing the risk of venous thromboembolism, particularly in young patients. We present the case of an 18-year-old woman with obesity and long-term estrogen-containing oral contraceptive use who presented with acute bilateral pulmonary emboli. Initial imaging noted polysplenia, but the diagnosis of heterotaxy syndrome with IVC interruption and azygos continuation was not made until 5 months later during evaluation for recurrent chest pain. Hypercoagulable workup was negative, and anticoagulation was continued due to ongoing thrombotic risk. This case highlights heterotaxy syndrome as an underrecognized contributor to venous thromboembolism in young individuals and underscores the importance of considering anatomical risk factors in cases of unprovoked thromboembolism.
2026 Clinician Corner - Rare occurrence of pancreatic adenocarcinoma metastasis to the brain
A 56-year-old man with known pancreatic adenocarcinoma presented to the emergency department with facial twitching and a left-sided facial droop. Magnetic resonance imaging of the brain and subsequent biopsy revealed metastatic pancreatic adenocarcinoma with no other metastatic sites shown on computed tomography of the chest, abdomen, and pelvis. Following craniotomy and tumor resection, the patient has shown clinical improvement with no deleterious complications to date.
Course summary
Available credit: 
  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
  • 1.00 American Board of Surgery (ABS) Accredited CME
    Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.
  • 1.00 AMA PRA Category 1 Credit™
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance
Course opens: 
03/01/2026
Course expires: 
03/01/2027
Cost:
$25.00

Riley Shin, BSA1, Helen Chen, MD2, Kristina Blegen, DO2, and Michelle Tarbox, MD2 

 

  1. School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA 

  1. Department of Dermatology, Texas Tech University Health Sciences Center, Lubbock, Texas, USA 

 

Corresponding author: Michelle Tarbox, MD, Texas Tech University, Physicians Medical Pavilion, 3601 4th St., 4th Floor, Lubbock, TX 79430 (e-mail: [email protected]) 

 

The planners and faculty for this activity have no relevant financial relationships to disclose. The authors report no funding. The patient consented to publication of this case report. 

Accreditation

The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation

AMA PRA Category 1 Credit™

The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABS CC

Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.

ABIM MOC

 Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

Available Credit

  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
  • 1.00 American Board of Surgery (ABS) Accredited CME
    Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.
  • 1.00 AMA PRA Category 1 Credit™
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance

Price

Cost:
$25.00
Please login or register for this course.