Disseminated keloids in a young man and interdisciplinary management

Summary: Abstract Body: Background: Keloids form from aberrant wound healing that leads to disorganized collagen synthesis and persistent inflammation. They most commonly appear in African Americans especially but also in skin of color generally. Widespread keloid formation however is rare and poses significant challenges for management. Clinical course: 28-year-old African American male presents as a new patient in December 2024 with disseminated keloids across his trunk, shoulders, and jaw angle. There is drainage on the chest and shoulders at times. The keloids began in early 2020 and have become larger and itchier in some places this past year. He was managed by Duke before consulting Wake Forest Baptist for a second opinion. Duke prescribed dupilumab 600 mg for the first two weeks and then 300 mg every two weeks afterwards starting August 2024. The pruritis is controlled with medical and intralesional triamcinolone and 5-fluorouricil 5% injection therapy, though it recurs just before his monthly appointments. The patient reports less pruritis and drainage from the keloids since starting dupilumab but believes the intralesional injections provide only some improvement. The large keloids on his right thigh were surgically removed. They recurred but have been more manageable. Wake Forest Baptist would like to continue dupilumab, gabapentin 100mg, naltrexone 50mg, and pentoxifylline 400mg for pruritis and the benzoyl peroxide 5% cleanser for super infection control. A referral was made to plastic surgery for excisions and intralesional triamcinolone injections. Conclusion: Where intralesional injections fail in large keloids, surgical excision is often the next step- though recurrence rates are very common without adjunct therapy. Silicone gel sheets, botulinum toxin A, radiotherapy, cryotherapy, interferon, and bleomycin have all demonstrated efficacy against keloids. Marc Gebara¹, Natalia Chalupczak², Meredith Yates³ 1. Center for Dermatology Research, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United States. 2. Rosalind Franklin University of Medicine and Science Chicago Medical School, North Chicago, IL, United States. 3. Dermatology, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United States. Genetic Disease, Gene Regulation, Gene Therapy & Epigenetics