Treating Kenalog Atrophy, Reducing Scarring During Wart Removal, and More

Tip 1: Handling Kenalog Atrophy

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When Kenalog or other steroids are accidentally injected into fat instead of muscle, significant and long-lasting atrophy, including indentation and epidermal changes, can occur. We briefly had a nurse practitioner who injected Kenalog-40 into a scar and proceeded to inject the same product into a pimple on the patient’s cheek, despite the patient questioning whether the concentration was too strong. When the patient returned, she had a cheek indentation big enough to hold half my fist.

Fortunately, there is a treatment for this. The problem persists because the steroid, which is particles in suspension, stays in contact with the skin and fat in the area. The treatment is to dissolve the remaining steroid with large amounts of saline. For this patient, I injected as much saline as I could into the area once every 2 weeks. After 3 or 4 months, everything had returned to normal, even the surface atrophy.

Gerald Bock, MD

Germantown, TN

Tip 2: Teaching Tools

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It can be difficult to find time to extensively teach our residents and medical students who work with us during our busy outpatient clinic and hospital consult days. I have found it beneficial to take a couple of minutes at the end of each half-day to enumerate 2 to 3 “take-home” clinical learning points for our trainees that are relevant to the patients we cared for that day, in addition to teaching at a patient’s bedside when time allows. Not only does this more effectively engage me and the resident/student, but it also illuminates that each patient has something to teach us that will make us better dermatologists.

David A. Wetter, MD

Rochester, MN 

Tip 3: Relief for Topical Minoxidil Itch

Some patients complain of itching with topical minoxidil. We know from the medical literature that this is more often related to a contact allergy to the preservative propylene glycol, which is in the 2% and 5% solution. If your patient complains of itching with the solution, ask them to try the foam 5% version instead. If they are nervous about putting it all over their head, suggest they try a patch test inside the arm or elbow first. 

Nicole Rogers, MD

Metairie, LA

Tip 4: Reduce Scarring During Wart Removal

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Consider treating isolated warts with electrocoagulation and curettage. The following technique works very well for me: 

  • Use a generous volume of local anesthesia. The plumped-up wart is treated with the hyfrecator, and the needle is inserted into several points successively (you may see bubbles coming out of it). The wart is cooked by the boiling anesthetic fluid. It can be easily curetted in one fell swoop and it comes out easily and bloodlessly. Anything remaining can be curetted off with a small curette and the bed very lightly fulgurated. This causes less scarring.

Mauricio Goihman-Yahr, MD, PhD

Caracas, Venezuela 

Dr. Barankin

Dr. Barankin is a dermatologist in Toronto, Ontario, Canada. He is author-editor of 7 books in dermatology and is widely published in the dermatology and humanities literature.