Chest Keloids – Case Study 8 – Butterfly Chest Keloid:
This 35-year-old male presented to our practice in October 2011 with several chest keloids that started about 10 years earlier. He was previously treated with steroid injections with minimal benefit. The dominant keloid was his butterfly shaped anterior chest keloid shown below.
With great difficulties, the whole keloid was treated with cryotherapy which resulted in thinning of the keloid. The loss of pigment was significant after recovery from the cryotherapy. Although some of the pigments returned, but the central part of the keloid never gained normal pigmentation. The serial photographs below show the evolution of this keloid over time and how challenging treating such large keloids are.
In 2022, Dr. Tirgan advised a different approach to very large keloids, whereby a complex surgical approach is used first to expand the normal skin nearby. Once enough skin is generated, the keloid is removed, and the line of surgical wound is treated with intra-lesional chemotherapy to prevent recurrence.
We then started treating the keloid with monthly intra-lesional chemotherapy and over next several months, there has been slow, yet ongoing improvement in the appearance and mass of this keloid.
This case demonstrates difficulties in treating this type of keloid. Butterfly type central chest keloid are the most difficult types of keloids to treat. This case also demonstrates that with continuous treatment, once can achieve gradual improvement in overall appearance and thickness of this type of keloid.