Suppurative keloids: a complication of severe keloid disease.

BACKGROUND: Some keloids show cystic cavities that give rise to acute inflammatory flares and oozing. These suppurative keloids (SK) have rarely been systematically studied. We conducted a retrospective cohort study to evaluate SK frequency and its risk factors. We also reviewed microbiological analyses as well as the histological features of removed SKs. METHODS: Between July 1, 2015, and September 30, 2016, all adult patients attending a specialized keloid clinic were asked to participate. Clinical information and microbiological results were extracted from each patient's file. Histological features were observed and interpreted. RESULTS: In this study, we observed an SK rate of 26% for a mean keloid history of 17.2 years. Male gender, African ancestry, and a family history of keloids were significantly associated with suppuration. Microbiological examination revealed commensal skin flora 7/9 (77.8%), Staphylococcus aureus 1/9 (11.1%), and Enterococcus faecalis 1/9 (11.1%). CONCLUSION: Suppuration is a common complication of keloids occurring in patients with severe keloid disease and may arise from pilosebaceous occlusion and aseptic inflammation.

Yellow Nail Syndrome Successfully Treated with Oral Terbinafine and Topical Minoxidil.

Yellow nail syndrome (YNS) is a rare disease of unknown etiology that is characterized by varying degrees of pulmonary manifestations, lymphedema, and yellow discoloration of the nails. Herein, we report the efficacy of oral terbinafine and topical minoxidil in treating the associated nail abnormalities of YNS in a 66-year-old woman. The patient presented with yellow, brittle, slow-growing nails, which had developed progressively over the past 8 months; left ankle edema; a chronic, purulent, productive cough; and exertional dyspnea. Based on these symptoms, she was diagnosed with YNS. She failed to respond to treatment with fluconazole and vitamin E; however, she was successfully treated with oral terbinafine and topical minoxidil. The treatment was well tolerated, and we speculate that its mode of action includes promoting lymphatic formation and barrier enhancement, thereby improving the distal lymphedema, in addition to distal vasodilation that accelerates the nail growth. To our knowledge, this is the first report of successful treatment of YNS using these agents.