Tips for Clinicians on Keloids and Other Conditions in Dermatology, With Andrew Alexis, MD, MPH

In an interview with HCPLive at the 2025 Fall Clinical Dermatology Conference in Las Vegas, Nevada, the editorial team spoke with Andrew Alexis, MD, MPH, regarding his segment of the session titled ‘30 Tips in 30 Minutes.’1

Alexis, professor of Clinical Dermatology and vice-chair for Diversity and Inclusion at Weill Cornell Medicine, touched on some of the tips included in his portion of the group panel at Fall Clinical. He first highlighted a tip regarding using liquid nitrogen cryotherapy for treating keloids.

“As we all know, intralesional triamcinolone injections are really a mainstay in the management of keloids,” Alexis explained. “But in some instances, adding light cryotherapy before injection has a few advantages. It can increase the efficacy of the result. Also, it can reduce the amount of force needed for the injection due to tissue edema post-cryotherapy. It also reduces the pain of injection for our patients. The biggest limitation, of course, is dyschromia.”

Alexis noted that one can end up inducing hypopigmentation as a complication of the liquid nitrogen, so he encouraged caution when using cryotherapy.

“One particular area where it's quite useful is for keloids that are located on the posterior earlobe, as an example of an area that's more hidden,” Alexis said. “So any dyschromia that occurs there is usually quite acceptable for patients. I showed a quick case of a before-and-after of a nodular keloid on the posterior ear lobe that was treated very successfully with a combination of cryotherapy, lightly, and intralesional triamcinolone, 40 milligrams per cc.”

Another tip Alexis highlighted related to the treatment of truncal acne. Alexis mentioned the value of using fourth-generation trifarotene, a retinoid for truncal acne.

“But in my tip, I show a patient who has truncal acne with acne on the back and severe post-inflammatory hyperpigmentation, and I show the multi-pronged approach to treating that patient, which included the retinoid, trifarotene, but also benzoyl peroxide wash and at some intervals, fluconazole for concomitant piterosporum folliculitis,” Alexis said. “[This] was noted on examination as multiple monomorphous, one to two millimeter follicular papules. This too can contribute to the overall neoform picture of an individual with neoform papules on their back. Don't forget to also look for pyterosporin folliculitis, and that can be treated with an oral antifungal.”

Alexis noted this patient had been treated with a series of salicylic acid-containing chemical peels to achieve a result of significant reduction in the acneiform papules and post-inflammatory hyperpigmentation.
For more about the content highlighted in Alexis’s session, view his video interview above.

View the latest coverage of Fall Clinical Dermatology for additional information on topics like this in dermatology.

Alexis has previously reported grants from Leo, Amgen, Galderma, Arcutis, Dermavant, AbbVie, Castle, and Incyte; advisory board/consulting fees from Leo, Galderma, Pfizer, Sanofi-Regeneron, Genzyme, Dermavant, Beiersdorf, Ortho, L’Oréal, Bristol Myers Squibb, Bausch Health, UCB, Arcutis, Janssen, Allergan, Almirall, AbbVie, Amgen, VisualDx, Eli Lilly, Swiss American, Cutera, Cara, EPI, Incyte, Castle, Apogee, Canfield, Alphyn, Avita Medical, Genentech, and Boehringer Ingelheim; speaker fees from Regeneron, Sanofi-Genzyme, Bristol Myers Squibb, L’Oréal, Janssen, J&J, and Aerolase; royalties from Springer, Wiley-Blackwell, Wolters Kluwer Health, and Elsevier.

References

1. Elewski B, Alexis A, Glick B, Kaufmann M, Lio P, Song J. 30 Tips in 30 Minutes. Session presentation at the 2025 Fall Clinical Dermatology Conference, Las Vegas, Nevada, Oct 23-26, 2025.