Complications

Complication
Timeframe
Likelihood
short term
high

Complications of intralesional corticosteroid therapy are common (reported in up to 63%) and include skin thinning, atrophy of the subdermal fat, telangiectasia, plaque formation, and pigmentary changes.[35]

short term
low

Systemic corticosteroid adverse side effects are possible following intralesional injection and can lead to adrenal suppression and Cushing syndrome. One systematic review confirmed 18 cases of Cushing syndrome after intralesional triamcinolone administration; 80% of cases occurred in children, and most after administration of more than 40 mg of triamcinolone within a period of 1 month.[35]

Systemic hormone imbalance may develop, which can result in water retention and menstrual irregularities in susceptible women.[24]

long term
low

There is a theoretical risk of radiation-induced carcinoma which is dependent on age, body site, radiation therapy dose, and technique.[78]​ A typical value would be 0.02% lifetime risk of skin cancer for radiation therapy to an earlobe keloid.[76]

variable
high

The most common complication independent of treatment is infection, with reported rates ranging from 22.4% to 42.6% in observational studies.[95][96][97]

It usually begins as a small abscess within the scar tissue which spontaneously discharges, leaving a draining sinus.

Treatment involves topical wound care together with systemic antibiotics, if there is significant inflammation.

variable
medium

Scarring can cause psychological problems, and these may be compounded by management that results in aggravation of the scar such as surgical intervention without adjuvant treatment. A quality of life study in China reported increased rates of interpersonal relationship sensitivity, depression, and anxiety among patients with keloids.[94]

Guidelines recommend psychosocial care to support and improve the quality of life in patients with scars.[21]

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