Annular scaly plaque confined to presternal keloid treated with intralesional injections

Sanjay Singh, Vishal Gupta, Somesh Gupta

 Department of Dermatology and Venereology, AIIMS, New Delhi, India

Correspondence Address:
Somesh Gupta
Department of Dermatology and Venereology, AIIMS, New Delhi
India

A 55-year-old woman received 10 intralesional injections of triamcinolone acetonide 40 mg/ml and 5-fluorouracil 50 mg/ml (1:9 ratio) once every 3–4 weeks, combined with cryotherapy (only in last four sessions) for her presternal keloid. Three weeks after the last injection, she presented with an itchy, erythematous, scaly plaque, circumferentially surrounding the elevated borders of keloid [Figure - 1]. A 10% KOH (potassium hydroxide) mount showed multiple branched septate hyphae. The dermatophytosis flared after treatment with terbinafine but responded to a combination of oral itraconazole and griseofulvin.

Figure 1: Well-defined, annular erythematous scaly plaque circumferentially confined to presternal keloid

This case is probably explained by the cutaneous anergy caused by intralesional immunosuppressive injections in keloid, which became the site of onset of dermatophytosis.

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Conflicts of interest

There are no conflicts of interest.