A resident at the Family Practice Clinic of the University of California, Davis, inserted a levonorgestrel implant (Norplant system) into a 25-year-old African-American women as she requested. The resident used the 7-step method recommended by the manufacturer to insert the implant. The woman went to the emergency department 24 hours after the insertion because the insertion site had diffuse redness, swelling, and blistering. Physicians prescribed 500 mg dicloxacillin every 6 hours for 10 days to treat suspected cellulitis. She returned to the clinic 1 week later, at which time the redness and blisters had disappeared. No drainage, fluctuance, or tenderness remained at the insertion site, which was clean. At her 3 month follow-up appointment, the insertion site itched constantly. The physician noted a fan-shaped area of hyperpigmentation at the insertion site. The physician prescribed 0.1% triamcinolone cream and told her to return for follow-up care. She returned in 3 months with complaints of itching and pain at the site. The physician noticed a fan-shaped keloid over the implant site and at the wound site. The patient asked for the implants to be removed. The physician did not encounter any difficulties in removing the 6 capsules and injected aqueous triamcinolone acetate into the keloid. Her mother had also experienced keloid formation. Resolution of the keloid at the implant site was noted at her 6-month follow-up visit. Based on a review of the literature, the cause of blister formation and subsequent keloid formation was likely multifactorial. The risk for keloid formation is highest in people with deeper skin pigmentation regardless of race, a family history of keloid, own history of keloid, and ethnic background. Patients should be counseled about the possibility of skin reactions such as keloid to implants.
|Original language||English (US)|
|Number of pages||3|
|Journal||Journal of the American Board of Family Practice|
|State||Published - 1994|
ASJC Scopus subject areas
- Public Health, Environmental and Occupational Health