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Xu Q, Bao C, Liu J, Zou Y, Zhu Y, Shen S, Fang F, Wang S, Lin M, Huang J, Gong T, Cheng B, Huang Z, Ji C. Effect of Epidermoid Cysts on the Efficacy of Intralesional Corticosteroid Therapy for Hypertrophic Scars and Keloids: A Prospective Pilot Study. Dermatol Surg 2024; 50:160-164. [PMID: 37962160 DOI: 10.1097/dss.0000000000004001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND Patients with hypertrophic scars (HSs) or keloids occasionally have epidermoid cysts (ECs), and the effect of ECs on the effectiveness of intralesional corticosteroids (ILCs) treatment in these patients has not been reported. OBJECTIVE This study aims to evaluate the influence of ECs on the outcomes of ILCs treatment in patients with HSs or keloids. MATERIALS AND METHODS This prospective study included 572 patients with keloids ( n = 461) or HSs ( n = 111). Patients received intralesional triamcinolone acetonide injection (0.05 mL/injection) at a concentration of 40 mg/mL and every 28 days for 4 sessions, with a 1-year follow-up. RESULTS A higher incidence of ECs was observed in keloid patients (16.92%) compared with HSs patients (7.21%). Keloid patients with ECs were older ( p = .008) and had a longer disease duration ( p = .0148), higher Vancouver scar scale (VSS) scores ( p = .04), and greater thickness ( p = .006). Keloid patients with ECs showed less improvement in VSS scores ( p < .0001) and thickness ( p < .0001) after ILCs treatment, with a higher recurrence rate ( p < .0001). The overall complication rate in keloid patients with ECs after ILCs treatment was 49.51%. CONCLUSION Epidermoid cysts under keloids were associated with a poor response to ILCs therapy. Therefore, it is recommended to incorporate ultrasonography as a routine examination for keloid patients to aid in better decision making in clinical practice.
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Affiliation(s)
- Qiuyun Xu
- Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Key Laboratory of Skin Cancer of Fujian Higher Education Institutions, the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Fujian Dermatology and Venereology Research Institute, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Chengbei Bao
- Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Key Laboratory of Skin Cancer of Fujian Higher Education Institutions, the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Fujian Dermatology and Venereology Research Institute, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Jian Liu
- Fuzhou Minebuty Medical Cosmetology Clinic, Fuzhou, Fujian, China
| | - Ying Zou
- Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Key Laboratory of Skin Cancer of Fujian Higher Education Institutions, the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Fujian Dermatology and Venereology Research Institute, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yanting Zhu
- Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Key Laboratory of Skin Cancer of Fujian Higher Education Institutions, the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Fujian Dermatology and Venereology Research Institute, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Shuyi Shen
- Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Key Laboratory of Skin Cancer of Fujian Higher Education Institutions, the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Fujian Dermatology and Venereology Research Institute, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Fang Fang
- Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Key Laboratory of Skin Cancer of Fujian Higher Education Institutions, the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Fujian Dermatology and Venereology Research Institute, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Songyu Wang
- Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Key Laboratory of Skin Cancer of Fujian Higher Education Institutions, the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Fujian Dermatology and Venereology Research Institute, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Mengting Lin
- Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Key Laboratory of Skin Cancer of Fujian Higher Education Institutions, the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Fujian Dermatology and Venereology Research Institute, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Jinwen Huang
- Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Key Laboratory of Skin Cancer of Fujian Higher Education Institutions, the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Fujian Dermatology and Venereology Research Institute, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Ting Gong
- Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Central Laboratory, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Bo Cheng
- Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Key Laboratory of Skin Cancer of Fujian Higher Education Institutions, the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Fujian Dermatology and Venereology Research Institute, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Zugen Huang
- Department of Plastic and Cosmetic Surgery, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Chao Ji
- Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Key Laboratory of Skin Cancer of Fujian Higher Education Institutions, the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Fujian Dermatology and Venereology Research Institute, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
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Yi JH, Park JW, Kim JG, Oh BH, Jung JW. Successful Treatment of Recurrent Earlobe Keloid Through Removal of Concealed Underlying Epidermoid Cysts: A Case Report. Cureus 2023; 15:e44602. [PMID: 37795062 PMCID: PMC10546951 DOI: 10.7759/cureus.44602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 10/06/2023] Open
Abstract
In modern clinical practice, earlobe keloids demonstrate a high cure rate through surgical intervention and suitable adjuvant therapies. Furthermore, the concurrence of keloids and epidermoid cysts is uncommon, potentially attributed to the lack of skin appendages within keloid tissue. This case report presents the successful treatment of a recurrent earlobe keloid through the removal of concealed underlying epidermoid cysts. The lesion recurred even after the second excision and proper adjuvant treatments. It was finally stabilized following the removal of epidermoid cysts within the earlobe at the third surgical procedure. These findings emphasize the importance of identifying underlying conditions associated with keloids and addressing inflammation, as these factors significantly influence treatment outcomes and resistance.
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Affiliation(s)
- Ju Hyeon Yi
- Department of Medicine, Yonsei University College of Medicine, Seoul, KOR
| | - Jung Won Park
- Department of Dermatology, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, KOR
| | - Joon-Goon Kim
- Department of Dermatology, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, KOR
| | - Byung Ho Oh
- Department of Dermatology, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, KOR
| | - Jin Woong Jung
- Department of Dermatology, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, KOR
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4
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Liang Z, Zhang M, Hao Y, Shan M, Liu H, Xia Y, Chen Q, Chang G, Wang Y. Risk factors associated with keloid infections: A five-year retrospective study. Int Wound J 2023. [PMID: 36746767 DOI: 10.1111/iwj.14099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/09/2023] [Indexed: 02/08/2023] Open
Abstract
Keloid infections reduce patient-reported quality of life greatly. Characteristics and risk factors of keloid infections have not been thoroughly studied. So, a retrospective cohort study was conducted focusing on the potential risk factors, microbiologic cultures and histological findings. Keloid patients consulting for surgical interventions were included in this study. Data were collected from their electronic medical records. 564 patients were recruited with the keloid infection rate being 22.4%. For adult patients, age above 40 years (OR, 2.84; P = .000), disease duration of 12 years or more (OR, 3.03; P = .000), the number of keloids over 3 (OR, 1.59; P = .050) and the presence of family history (OR, 1.91; P = .027) were significantly associated with keloid infections. Suppurative keloids were located mostly in thorax (61.79%). For the under-age subgroup(n = 25), family history was frequently seen in patients with infections. Microbiologic cultures revealed a mixed spectrum of bacteria including Staphylococcus (25%), Actinomyces (30%) and Prevotella (10%). The rate of epidermoid cysts was 19.7% in histological examination. Age > 40 years, disease duration ≥12 years, the number of keloids >3 and the presence of family history are risk factors for keloid infections.
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Affiliation(s)
- Zhengyun Liang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China.,Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Mingzi Zhang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Yan Hao
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China.,Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Mengjie Shan
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China.,Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hao Liu
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Yijun Xia
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China.,Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qiao Chen
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Guojing Chang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Youbin Wang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China
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6
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Liu Y, Su X, Hu J, Zhan S, Wang M, Wang L. Treatment of sebaceous cysts in keloids: Ultrapulse mode-fractionated carbon dioxide lasers combined with injection of low-concentration triamcinolone acetonide and 5-fluorouracil. J Cosmet Dermatol 2021; 21:3169-3171. [PMID: 34806298 DOI: 10.1111/jocd.14593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/11/2021] [Accepted: 11/01/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Yue Liu
- Department of Cicatrix Minimally Invasive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xueshang Su
- Department of Cicatrix Minimally Invasive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jintian Hu
- Department of Cicatrix Minimally Invasive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sien Zhan
- Department of Medical Laboratory, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meng Wang
- Department of Cicatrix Minimally Invasive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lianzhao Wang
- Department of Cicatrix Minimally Invasive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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8
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Pérez-Wilson J, Whittle C, García V, Norris F, Castro A, Hitschfeld M. Ulcerated Keloid Secondary to a Coexisting Complicated Epidermal Inclusion Cyst: A Sonographic Diagnosis. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2020. [DOI: 10.1177/8756479320914517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Keloid is a benign fibroblastic tumor that is most often secondary to tissue injury. The clinical presentation is a hard red or purple tumor, mostly itchy or painful. The clinical objectives are to report an ulcerated keloid secondary to a central or inner complicated epidermal inclusion cyst histologically proven and to describe the sonographic findings that permitted the diagnosis. A 29-year-old man with multiple large keloids on the chest wall presented with a two-day pain history, increased volume, and ulceration on one side. Physical examination showed a keloid with edema, peripheral erythema, and a 1-cm central ulcer with purulent discharge. On the sonogram, multiple solid dermal hypodermal pseudotumors were visualized. The lesions were well-defined hypoechogenic heterogeneous solid masses that were hypovascular with color Doppler, concordant with keloids. Within the ulcerated enlarged mass, a complicated epidermal inclusion cyst was discovered with inflammatory changes. The significance of this case lies in the very low frequency of ulceration of a keloid and the high diagnostic value of sonography to demonstrate the presence of a coexisting epidermal inclusion cyst. In the differential diagnosis of an ulcerated keloid, sonography can assist in achieving a better presurgical approach.
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Affiliation(s)
- Jaime Pérez-Wilson
- Department of Dermatology, Clínica Alemana de Santiago de Chile, Vitacura, Metropolitan Region, Chile
| | - Carolina Whittle
- Associate Professor, Facultad de Medicina. Universidad del Desarrollo, Radiology Department, Clínica Alemana de Santiago, Chile
| | - Viviana García
- Department of Dermatology, Clínica Indisa, Santiago, Metropolitana, Chile
| | - Frances Norris
- Resident of Dermatology, Universidad del Desarrollo - Clínica Alemana de Santiago, Chile
| | - Alex Castro
- Pathology Department, Clínica Alemana de Santiago, Chile
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