 FIGURE 1 |
 FIGURE 2 |
This patient had keloids—dermal fibrotic lesions (FIGURE 1) that are a variation of the normal wound healing process in the spectrum of fibroproliferative disorders. Keloids can occur up to a year after an injury and enlarge beyond the scar margin. Keloids are more common in individuals with darker pigmentation.
Patients frequently want keloids treated because of symptoms (pain and pruritus) and concerns about appearance. Cryosurgery and intralesional triamcinolone have been used to treat keloids with some success. Intralesional steroid injections of triamcinolone acetonide (10–40 mg/mL) may decrease pruritus, as well as keloid size. These injections may be repeated monthly, as needed. Silicone gel sheeting as a treatment for hypertrophic and keloid scarring is supported by poor-quality trials only.
This patient opted for intralesional steroids (FIGURE 2) to the most symptomatic keloids. The patient understood that the injection would not remove the keloid, but it did eliminate the pruritus and pain at the site.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Varela A, Usatine R. Keloids. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:878-880.
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