Acne Keloidalis Nuchae

Aka: Acne Keloidalis Nuchae, Folliculitis Keloidalis Nuchae

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II. Pathophysiology

  1. Idiopathic, chronic inflammatory condition leading to Hair Follicle scarring
  2. May be secondary to localized foreign body reaction to hair (similar to Pseudofolliculitis Barbae)
  3. Increased androgen levels play a part in pathogenesis (hence male predisposition)

III. Epidemiology

  1. Most common in black men
    1. Also occurs in hispanic, asian and white men
    2. Women are much less commonly affected (male to female 20:1)
  2. Onset after Puberty and typically not after age 50 years

IV. Symptoms

  1. Variable pain and Pruritus

V. Signs

  1. Papules and Pustules on occiput and neck (each 2-4 mm)
  2. Papules and coalesce into Keloid-like mass in band-shape on the occipital scalp and posterior neck
  3. Cicatricial Alopecia occurs in involved neck and occiput region

VI. Associated Conditions

  1. Metabolic Syndrome
  2. Hidradenitis Suppurativa

VII. Complications

  1. Subcutaneous abscess with draining sinus
  2. Scarring Alopecia in involved area

VIII. Management

  1. General Measures
    1. Avoid tight fitting shirts, helmets, hats or other clothing that rubs the occipital and nuchal area
    2. Avoid shaving or tightly clipping hairs in the occipital and nuchal region
  2. Initial medical management
    1. Topical Corticosteroids
      1. Start with topical Triamcinolone 0.1% cream for 3 to 4 weeks in mild cases (Papules <3 mm)
      2. High protency Topical Corticosteroids (e.g. Clobetasol, Betamethasone) may be needed in more significant cases
    2. Intralesional Triamcinolone (5 to 40 mg/ml)
      1. Consider in moderate cases (Papules >3 mm)
    3. Topical Retinoids (e.g. Retin A)
      1. Consider as adjunct to Corticosteroids
    4. Topical Antibiotics (e.g. Clindamycin 1% solution)
      1. Consider if Pustules are present
  3. Additional medical management
    1. Oral Antibiotics (e.g. Doxycycline)
    2. Imiquimod (Aldara)
    3. Oral Isotretinoin (Accutane)
    4. Cryotherapy
  4. Refractory cases
    1. Laser Therapy (most effective)
      1. Woo (2018) J Cutan Med Surg 22(2): 236-8 [PubMed]
    2. Phototherapy (UVB)
      1. Okoye (2014) Br J Dermatol 171(5): 1156-63 [PubMed]
    3. Surgical excision

IX. References

  1. Frazier (2023) Am Fam Physician 107(1): 26-34 [PubMed]
  2. Kundu (2013) Am Fam Physician 87(12): 859-65 [PubMed]
  3. Maranda (2016) Dermatol Ther 6(3): 363-78 [PubMed]

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Related Studies

Ontology: Acne Keloid (C0001145)

Definition (NCI) A chronic eruption of fibrous papules that develop and fuse to form a thick sclerotic, hypertrophic band at a site of deep folliculitis, usually along the posterior hairline of the scalp. It is most commonly seen in men of African descent.
Definition (MSH) A type of acneiform disorder in which secondary pyogenic infection in and around pilosebaceous structures ends in keloidal scarring. It manifests as persistent folliculitis of the back of the neck associated with occlusion of the follicular orifices. It is most often encountered in black or Asian men.
Concepts Disease or Syndrome (T047)
MSH D000153
ICD10 L73.0
SnomedCT 201227000, 201206005, 238742005, 238746008, 403362001
English Acne Keloid, Acne Keloids, Keloid, Acne, Keloids, Acne, Acne Keloidalis, Folliculitis Keloidalis, Keloidal Acne, Acne, Keloidal, Keloidal Acnes, acne keloidalis (diagnosis), acne keloidalis, Acne Keloid [Disease/Finding], acne keloid, keloid acne, acne keloids, Keloidal folliculitis, Acne cheloidalis, Acne keloidalis, Acne keloid, Acne keloid (disorder), Acne keloidalis (disorder), Keloidal acne, keloid; acne, acne; keloid, Keloidal Folliculitis
Dutch keloïde acne, keloïde folliculitis, acne; keloïd, keloïd; acne, Acne-keloïd, Acne keloidea, Keloïd-acne
German keloidale Follikulitis, Aknenarbe, Aknekeloid [Folliculitis sclerotisans nuchae], Acne keloidales, Aknekeloid, Folliculitis scleroticans nuchae, Folliculitis sclerotisans nuchae
Italian Acne cheloide, Follicolite cheloidale, Acne cheloidale, Acne cheloidea
Portuguese Acne quelóide, Foliculite queloidal, Acne Queloide, Acne Queloidal
Spanish Foliculitis queloide, Acné queloide, acné queloidal (trastorno), acné queloidal, acné queloide (trastorno), acné queloide, Acné Queloidal, Acné Queloide
Swedish Akneärr
Japanese ｹﾛｲﾄﾞｻﾞｿｳ, ｹﾛｲﾄﾞｾｲﾓｳﾎｳｴﾝ, ケロイドアクネ, ざ瘡ケロイド, ケロイドざ瘡, ケロイド性毛包炎, ケロイド状ざ瘡, 頭部乳頭状皮膚炎, ケロイド性毛嚢炎, 皮膚炎-頭部乳頭状
Czech akné keloidní, Folliculitis nuchae sclerotisan, Acne keloidea
Finnish Keloidiakne
Russian FOLLIKULIT KELOIDNYI, AKNE-KELOID, АКНЕ-КЕЛОИД, ФОЛЛИКУЛИТ КЕЛОИДНЫЙ
French Folliculite chéloïdienne, Acné chéloïdienne
Korean 켈로이드성 여드름
Polish Trądzik bliznowcowy
Hungarian Folliculitis keloidalis, Acne keloid
Norwegian Aknekeloid, Acne keloidales, Folliculitis scleroticans nuchae, Aknearr
Derived from the NIH UMLS (Unified Medical Language System)

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