Acne keloidalis nuchae

Hebra u. Kaposi, 1860.

Acne keloidalis nuchae, Acne sclerotisans nuchae, Folliculitis keloidalis, Dermatitis papillaris capillitii (Kaposi), Nuchal keloid, Sycosis framboesiformis (Hebra), Sycosis nuchae sclerotisans.

Chronic fibrosing folliculitis, which can lead to cicatricial (keloidal) alopecia in males.

• Blacks more often affected.
• Almost only men affected.
• Peak in frequency 20-40 y.

Unclear, probably a staphylococcal infection or an infection with Gram-negative pathogens.

At the neck-hair boundary arranged pustules and often already scarring.

• Clinic
• Bact. smear if necessary

Evolution of spinocellular carcinoma on the scars has been described.

Chronic progression.

• No shaving!

• The only permanent solution is excision. Secondary wound healing is possible and usually results in good cosmetic results
• Laser epilation can also bring the process to a halt.

Systemic therapies are often unsuccessful! What can be tried:

• Antibiotic therapy: best after antibiogram, otherwise
• Doxycycline p.o. 100 mg 1-2x daily for 14- 21 days
• Isotretinoin: usually without improvement

• Trial intralesional therapy with triamcinolone
• Triamcinolone (mixed with a local anaesthetic 3:1)
  • 10 mg suspension for injection
  • 40 mg suspension for injection

• Cryotherapy can be started at the same time.

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2. Kelly AP. Pseudofollikulitis barbae and Akne keloidalis nuchae. Dermatol Clin 2003;21:645-53.
3. Ogunbiyi A, George A. Akne keloidalis in females: case report and review of literature. J Natl Med Assoc 2005;97:736-8.
4. Taylor SC. Epidemiology of skin diseases in ethnic populations. Dermatol Clin 2003;21:601-7.
5. Khumalo NP, Jessop S, Ehrlich R. Prevalence of cutaneous adverse effects of hairdressing: a systematic review. Arch Dermatol 2006;142:377-83.