Banda Chihena H, Ngalamika Owen, Zuze Victor M, Bwanga Alick, Mumba Chibamba
Plastic and Reconstructive Surgery Unit Department of Surgery University Teaching Hospital Lusaka Zambia.
Department of Dermatology University Teaching Hospital Lusaka Zambia.
Skin Health Dis. 2024 Apr 11;4(4):e387. doi: 10.1002/ski2.387. eCollection 2024 Aug.
Keloids are benign fibroproliferative tumours with a high recurrence rate of 20%-100%, therefore, multimodal treatment is recommended. We report the case of an exceptionally large facial keloid precipitated by a vicious cycle of chronic inflammation and mechanical skin traction and discuss the management challenges in a low resource setting. A 67-year-old man presented with a 10-year history of a facial keloid that rapidly enlarged to 2,800 g in 2 years causing difficulties eating, speaking, dressing, head movements and breathing. He had multiple other smaller keloids, hypertension, HIV, and a keloid family history. Surgical excision of the keloid including the multiple sinuses and cysts of enclosed skin with growing hair found inside was performed. A posterior skin flap was used to achieve tension free closure and monthly triamcinolone injections commenced. Histology showed keloidal collagen bundles in a fibrotic background, foci of a lymphoplasmacytic infiltrate and multinucleated foreign body type giant cells consistent with chronic inflammation. CD34 and S100 immunohistochemistry were both negative, ruling out the differential diagnoses that included dermatofibroma. Recovery was uneventful and the patient was discharged after 2 weeks. Notably, radiotherapy was not available in our country. We report this unique case of an extremely large keloid to demonstrate the role of suppurative chronic inflammation and high skin tension in accelerated keloid growth. This case also highlights the severe global disparity in the availability of effective keloid treatment and the urgent need for access to radiotherapy services especially in Africa where keloid prevalence is highest.
瘢痕疙瘩是一种良性纤维增生性肿瘤，复发率高达20%-100%，因此，建议采用多模式治疗。我们报告了一例因慢性炎症和机械性皮肤牵引的恶性循环而导致的异常巨大的面部瘢痕疙瘩病例，并讨论了在资源匮乏地区的治疗挑战。一名67岁男性，有面部瘢痕疙瘩病史10年，在2年内迅速增大至2800克，导致进食、说话、穿衣、头部活动及呼吸困难。他还有多个其他较小的瘢痕疙瘩、高血压、艾滋病毒，且有瘢痕疙瘩家族史。对瘢痕疙瘩进行了手术切除，包括切除内部有生长毛发的封闭皮肤的多个窦道和囊肿。采用后皮瓣实现无张力缝合，并开始每月注射曲安奈德。组织学显示在纤维化背景中有瘢痕疙瘩样胶原束、淋巴细胞浆细胞浸润灶和多核异物型巨细胞，符合慢性炎症表现。CD34和S100免疫组化均为阴性，排除了包括皮肤纤维瘤在内的鉴别诊断。恢复过程顺利，患者在2周后出院。值得注意的是，我国没有放疗设备。我们报告这例极其巨大的瘢痕疙瘩的独特病例，以证明化脓性慢性炎症和高皮肤张力在瘢痕疙瘩加速生长中的作用。该病例还凸显了有效治疗瘢痕疙瘩的可及性在全球范围内存在的严重差距，以及迫切需要获得放疗服务，尤其是在瘢痕疙瘩患病率最高的非洲地区。
