{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T03:03:40Z","timestamp":1778209420520,"version":"3.51.4"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2024,11,14]],"date-time":"2024-11-14T00:00:00Z","timestamp":1731542400000},"content-version":"vor","delay-in-days":217,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Keloids are benign fibroproliferative tumours with a high recurrence rate of 20%\u2013100%, therefore, multimodal treatment is recommended. We report the case of an exceptionally large facial keloid precipitated by a vicious cycle of chronic inflammation and mechanical skin traction and discuss the management challenges in a low resource setting. A 67-year-old man presented with a 10-year history of a facial keloid that rapidly enlarged to 2,800 g in 2 years causing difficulties eating, speaking, dressing, head movements and breathing. He had multiple other smaller keloids, hypertension, HIV, and a keloid family history. Surgical excision of the keloid including the multiple sinuses and cysts of enclosed skin with growing hair found inside was performed. A posterior skin flap was used to achieve tension free closure and monthly triamcinolone injections commenced. Histology showed keloidal collagen bundles in a fibrotic background, foci of a lymphoplasmacytic infiltrate and multinucleated foreign body type giant cells consistent with chronic inflammation. CD34 and S100 immunohistochemistry were both negative, ruling out the differential diagnoses that included dermatofibroma. Recovery was uneventful and the patient was discharged after 2 weeks. Notably, radiotherapy was not available in our country. We report this unique case of an extremely large keloid to demonstrate the role of suppurative chronic inflammation and high skin tension in accelerated keloid growth. This case also highlights the severe global disparity in the availability of effective keloid treatment and the urgent need for access to radiotherapy services especially in Africa where keloid prevalence is highest.<\/jats:p>","DOI":"10.1002\/ski2.387","type":"journal-article","created":{"date-parts":[[2024,4,11]],"date-time":"2024-04-11T06:50:03Z","timestamp":1712818203000},"source":"Crossref","is-referenced-by-count":2,"title":["Massive Facial Keloid Precipitated by Chronic Suppuration and Mechanical Skin Traction: A Case Report"],"prefix":"10.1093","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2743-4218","authenticated-orcid":false,"given":"Chihena H.","family":"Banda","sequence":"first","affiliation":[{"name":"Plastic and Reconstructive Surgery Unit, Department of Surgery, University Teaching Hospital , Lusaka ,","place":["Zambia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Owen","family":"Ngalamika","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University Teaching Hospital , Lusaka ,","place":["Zambia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victor M.","family":"Zuze","sequence":"additional","affiliation":[{"name":"Department of Pathology and Microbiology, University Teaching Hospital , Lusaka ,","place":["Zambia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alick","family":"Bwanga","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Teaching Hospital , Lusaka ,","place":["Zambia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chibamba","family":"Mumba","sequence":"additional","affiliation":[{"name":"Department of Pathology and Microbiology, University Teaching Hospital , Lusaka ,","place":["Zambia"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,4,11]]},"reference":[{"key":"2025112605415966200_ski2387-bib-0001","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1016\/J.JPRA.2019.09.004","article-title":"Keloid pathophysiology: fibroblast or inflammatory disorders?","volume":"22","author":"Nangole","year":"2019","journal-title":"JPRAS Open"},{"issue":"3","key":"2025112605415966200_ski2387-bib-0002","doi-asserted-by":"publisher","DOI":"10.3390\/ijms18030606","article-title":"Keloid and hypertrophic scars are the result of chronic inflammation in the reticular dermis","volume":"18","author":"Ogawa","year":"2017","journal-title":"Int J Mol Sci"},{"issue":"11","key":"2025112605415966200_ski2387-bib-0003","doi-asserted-by":"publisher","first-page":"1392","DOI":"10.1111\/ijd.15641","article-title":"Suppurative keloids: a complication of severe keloid disease","volume":"60","author":"Delaleu","year":"2021","journal-title":"Int J Dermatol"},{"issue":"2","key":"2025112605415966200_ski2387-bib-0004","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2022.5607","article-title":"Comorbidities of keloid and hypertrophic scars among participants in UK Biobank","volume":"159","author":"Ung","year":"2023","journal-title":"JAMA Dermatol"},{"issue":"2","key":"2025112605415966200_ski2387-bib-0005","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1111\/j.1524-475X.2012.00766.x","article-title":"The relationship between skin stretching\/contraction and pathologic scarring: the important role of mechanical forces in keloid generation","volume":"20","author":"Ogawa","year":"2012","journal-title":"Wound Repair Regen"},{"key":"2025112605415966200_ski2387-bib-0006","doi-asserted-by":"publisher","DOI":"10.1177\/2050313X20936033","article-title":"Multidisciplinary treatment of a massive head and neck keloid scar: a case report","volume":"8","author":"Longowal","year":"2020","journal-title":"SAGE Open Med Case Rep"},{"issue":"8","key":"2025112605415966200_ski2387-bib-0007","doi-asserted-by":"publisher","first-page":"2455","DOI":"10.1016\/J.BJPS.2022.04.099","article-title":"Radiation therapy modalities for keloid management: a critical review","volume":"75","author":"Liu","year":"2022","journal-title":"J Plast Reconstr Aesthetic Surg"},{"key":"2025112605415966200_ski2387-bib-0008","volume-title":"Cancer patients to be referred to Tanzania at government\u2019s cost, reveals Sylvia Masebo","author":"Mwebantu Editor","year":"2023"},{"issue":"3","key":"2025112605415966200_ski2387-bib-0009","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000002582","article-title":"Keloids: which types can Be excised without risk of recurrence? 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