Combination Therapy for a Severe Axillary Keloid with Abscesses: A Novel Case Report

Keloids are laterally growing fibroproliferative skin disorders. In severe cases, keloids spread widely, sometimes over joints, thus significantly limiting motor function. Severe keloids also associate with repeated and very painful draining infections. Here, we report the case of a giant keloid that was successfully treated by combination therapy composed of surgery (partial resection followed with local flap transposition) followed by radiotherapy and steroid-plaster therapy. The keloid of the patient started growing at the age of 7 from the BCG injection that she received on her left shoulder in infancy. The keloid grew rapidly and widely after adulthood. Malignant tumor was suspected at another hospital but a biopsy at the age of 45 indicated it was a keloid. Thereafter, the keloid grew from the shoulder onto the chest and back and over the anterior axilla. At 62 years of age, the patient was referred to our hospital. After providing general anesthesia, the keloid was partially resected and the wound was covered with a local flap. Postoperative radiotherapy was performed 1 week later. The residual keloid was treated for 18 months with steroid tape. Eighteen months after surgery, keloid recurrence was not observed. The patient had no pain or movement restriction. She was extremely satisfied with the results and considered the treatment to have improved her quality of life. While a standard strategy for severe keloid remains to be established, combination therapy composed of surgery, postoperative radiotherapy, and steroid-plaster therapy that aims to reduce inflammation and skin tension may be an option.