Systemic ketoconazole is excreted in breast milk. In a case report of one mother prescribed 200 mg PO daily for 10 days, ketoconazole milk concentrations of micrograms/ml (peak) were observed hours post-dose and were undetectable at 24 hours post-dose. Assuming a milk intake of 150 ml/kg/day, the author calculated the daily ketoconazole dose of an exclusively breast-fed infant at mg/kg/day or % of the mother's weight-adjusted dose. The manufacturer recommends mothers refrain from nursing their infants during oral therapy; however, the American Academy of Pediatrics (AAP) considers ketoconazole compatible with breast-feeding. There are no adequate and well-controlled studies of topical use in nursing women; however, ketoconazole is not detected in plasma after chronic shampooing on the scalp. If the topical gel is used during breast-feeding and is applied to the chest, care should be taken to avoid accidental ingestion by the infant. Fluconazole may be a potential alternative to consider during breast-feeding. However, site of infection, patient factors, local susceptibility patterns, and specific microbial susceptibility should be assessed before choosing an alternative agent. Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition. If a breast-feeding infant experiences an adverse effect related to a maternally ingested or administered drug, health care providers are encouraged to report the adverse effect to the FDA.
Smaller keloids can be flattened with a more concentrated kenalog (steroid) injection. Some doctors will add 5-fluorouracil to the mix. In my experience it is better to debulk or complete cut out larger keloids (like your 2x2cm one) and then use modalities to stop the keloid from coming back. These modalities are application of pressure with more kenalog injections as needed or radiation treatments to scar line. Topical steroid mostly that which is impregnated into a tape that is applied to the skin can soften a hypertrophic scar or prevent a keloid from coming back. In my experience the topical steroid alone will not clear a keloid that has already formed.