KELOID MASQUERADING AS ACNE CONGLOBATA: A CASE REPORT
Wirya, Stephen Akihiro
Oeiria, David Sudarto
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Background: Keloids are characterized by dense, fibrous tissue nodules. Formation of keloids are usually preceded by previous trauma, but may also appear spontaneously. Keloids may also be pruritic and painful, and generally does not regress spontaneously. In case of preceding traumas, keloids enlarge beyond the size and location of original trauma site but rarely extend deep into the underlying subcutaneous tissue. Acne conglobata is a subtype of acne predominantly found in young males characterized by painful severe nodular inflammation, abscesses and sinus tracts. This type of acne always require more aggressive treatment due to the intense degree of inflammation involved. The location, presence of nodular formations and its tendency to be resistant to treatment may cause difficulty in distinguishing keloids in patients with acne vulgaris from acne conglobata. Close dermatological inspection by stretching the skin and good examination light at a shallow angle will aid in diagnosis which will result in correct treatment applied. Observation: An 18-year-old male complained of acne on face and trunk two years prior to coming to our centre, with worsening during the past year. Although acne had been extensively treated using multiple regimens of both oral and topical medications, the patient has not experienced any improvement. Dermatology examination on the face, chest and back revealed multiple erythematous to skin colored smooth firm nodules along with some erythematous papules and comedones. Close inspection showed that the patient suffered from a mixture of multiple acne cyst-like keloid formations in addition to mild acne vulgaris. We thus treated the patient using series of intralesional steroid injections in addition to acne medications appropriate for mild acne vulgaris.