Acne keloidalis nuchae
Last Updated: 2020-06-15
Hebra u. Kaposi, 1860.
Acne sclerotisans nuchae, folliculitis keloidalis, dermatitis papillaris capillitii (Kaposi), neck keloid, sycosis framboesiformis (Hebra), sycosis nuchae sclerotisans.
Chronic-fibrosing folliculitis, which can lead to scarring (keloidal) alopecia in men.
- Dark-skinned men are by far the most affected.
- Frequency peaks between 15-25 years.
- Most common in individuals of African descent.
Unclear, possibly triggered by staphylococcal infection or gram-negative bacteria.
Follicular papules or pustules arranged at the neck hair line. Subsequently, development of hard, globular papules and nodes. They are often perforated by the remaining hair. The scars can turn into keloids and show confluence. Deep sinuses can develop. Paintbrush-like hair follicles occur by fusing of several follicular infundibulae.
- Clinical features.
- Upon presence of pus, perform bacterial swab.
Development of a squamous cell carcinoma on the scars has been described. This often occurs in regions of chronic inflammation.
Chronic course of the disease.
- Avoid shaving the affected regions.
- Only excision can help in the long run. Secondary wound healing is possible and usually also produces good cosmetic results.
- Laser epilation can also interrupt the process.
Systemic therapies are often unsuccessful! It can be tried:
- Antibiotic therapy: best according to antibiogram; otherwise:
- Doxycycline p.o. 100 mg 1-2x daily for 14-21 days.
- Isotretinoin: No evidence based reviews available.
- Intralesional therapy with triamcinolone.
- Triamcinolone (mixed with a local anesthetic 3:1).
- Triamcinolone 10 mg injection suspension.
- Triamcinolone 40 mg injection suspension.
- Cryotherapy can be started at the same time.
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