This is a 51-year-old female who four years earlier, at age of 47, underwent coronary bypass surgery. Soon after surgery, keloids started forming at the surgical wound sites. A surgical resection of the midline keloid was performed about a year later, yet the problem returned even worse than before.
With the recurrence after surgery, she received several steroid injections without much success. Over time, her keloid became very painful to a point that simple touching of the skin caused her tremendous pain.
This is a challenging case, and very typical of the sternal keloids that almost always relapse after surgery. The main issue for this patient was pain which interfered with her daily life as well as her sleep.
First goal in treating patients like her is pain control which cannot be achieved without treating the underlying cause. With failure of steroids, the next best option is treatment with chemotherapy. Patient consented to the treatment on Sept 4, 2014, however her skin was so painful that we were only able to inject the top 1 inch of her keloid on that day. She was practically in tears from pain which was aggravated with the injections. We had to interrupt her treatment on that day.
She returned on September 23, 2014 to continue the treatment. Although only a small portion of the whole lesion was previously injected with chemotherapy, she had achieved almost near total pain relief in that area. This significant pain relief encouraged her to return for more treatment, which we were able to accomplish on the same day. It is of interest, that the top part of her keloid had clear evidence of regression that wad due to partial injection of three weeks earlier.
In 2020, with results seen using the R6 cream, Dr. Tirgan will use R6 cream in treating such patients before resorting to intra-lesional chemotherapy.