What is the treatment for a chest keloid infection?

Treatment of Chest Keloid Infection

Infected chest keloids should be treated with intralesional corticosteroid injections combined with appropriate antibiotics to address both the infection and underlying keloid pathology. 1, 2

Initial Management of Infected Keloid

Antibiotic Treatment

• For community-acquired chest keloid infections:
  • First-line: Amoxicillin-clavulanic acid 1g/125mg three times daily 3
  • Alternative: Clindamycin 300mg four times daily (if penicillin allergic) 3
• For hospital-acquired chest keloid infections:
  • First-line: Piperacillin-tazobactam 4.5g four times daily IV 3
  • Alternative: Meropenem 1g three times daily IV 3

Drainage Considerations

• If fluctuant areas are present, needle aspiration should be performed for both diagnostic and therapeutic purposes 3
• Incision and drainage is usually unnecessary except for very large collections 4
• Send aspirated material for culture and sensitivity testing to guide antibiotic therapy 3

Keloid-Specific Treatment

First-Line Therapy

• Intralesional corticosteroid injections (triamcinolone acetonide 10-40 mg/mL) 1, 2
  • Administer every 2-4 weeks
  • Continue for 3-6 months depending on response
• Combine with silicone gel sheeting or silicone sheets for optimal results 2

For Recalcitrant Infected Keloids

• Consider adding intralesional 5-fluorouracil (5-FU) or bleomycin to corticosteroid injections 2
• For large, persistent infected keloids, surgical excision followed by immediate radiation therapy may be necessary 2
• For occipital keloids with active infection, excision with secondary intention healing has shown success 5

Monitoring and Follow-up

• Regular clinical assessment every 1-3 months to evaluate:
  • Resolution of infection
  • Response to keloid treatment
  • Need for treatment modification
• Continue monitoring for at least 6-12 months after apparent resolution to detect early recurrence

Special Considerations

Pitfalls to Avoid

• Avoid superficial treatments that don't address the reticular dermis, as keloids arise from chronic inflammation in this layer 4
• Don't rely solely on topical antibiotics, as they typically don't penetrate deeply enough into the keloid tissue
• Avoid premature discontinuation of treatment, as this increases risk of recurrence
• Remember that keloids have a genetic component, so patients may be predisposed to recurrence 6

Treatment Challenges

• Keloid treatment is highly heterogeneous with no standardized approach 1
• Treatment should be tailored based on keloid size, location, and previous treatment response
• Chest keloids are particularly challenging to treat and have higher recurrence rates than keloids in other locations

By addressing both the infection and the underlying keloid pathology simultaneously, this approach offers the best chance for resolution of the infected keloid and prevention of recurrence.