II. Pathophysiology
- Idiopathic, chronic inflammatory condition leading to Hair Follicle scarring
- May be secondary to localized foreign body reaction to hair (similar to Pseudofolliculitis Barbae)
- Increased androgen levels play a part in pathogenesis (hence male predisposition)
III. Epidemiology
- Most common in black men
- Also occurs in hispanic, asian and white men
- Women are much less commonly affected (male to female 20:1)
- Onset after Puberty and typically not after age 50 years
IV. Symptoms
- Variable pain and Pruritus
V. Signs
VI. Associated Conditions
VII. Complications
- Subcutaneous abscess with draining sinus
- Scarring Alopecia in involved area
VIII. Management
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General Measures
- Avoid tight fitting shirts, helmets, hats or other clothing that rubs the occipital and nuchal area
- Avoid shaving or tightly clipping hairs in the occipital and nuchal region
- Initial medical management
- Topical Corticosteroids
- Start with topical Triamcinolone 0.1% cream for 3 to 4 weeks in mild cases (Papules <3 mm)
- High protency Topical Corticosteroids (e.g. Clobetasol, Betamethasone) may be needed in more significant cases
- Intralesional Triamcinolone (5 to 40 mg/ml)
- Consider in moderate cases (Papules >3 mm)
- Topical Retinoids (e.g. Retin A)
- Consider as adjunct to Corticosteroids
- Topical Antibiotics (e.g. Clindamycin 1% solution)
- Consider if Pustules are present
- Topical Corticosteroids
- Additional medical management
- Oral Antibiotics (e.g. Doxycycline)
- Imiquimod (Aldara)
- Oral Isotretinoin (Accutane)
- Cryotherapy
- Refractory cases
- Laser Therapy (most effective)
- Phototherapy (UVB)
- Surgical excision