SKINIPEDIA - Skin Encyclopedia: Acne Keloidalis Nuchae

Acne Keloidalis Nuchae

Folliculitis keloidalis (also called acne cheloidalis nuchae, and acne keloidalis) is an unusual skin condition affecting the nape of the neck. It commonly affects adult Afro-Caribbean males with curly hair and other dark-skinned individuals, but it can occur in any individual. The condition may persist for many years. It is very uncommon in women. In addition, acne keloidalis nuchae is very rarely seen in people prior to puberty or after middle age.

Although it is not related to common acne (acne vulgaris), acne keloidalis nuchae initially appears as acne-like lesions of inflamed hair follicles (folliculitis) on the nape of the neck (nuchal area) and, without treatment, can result in large scars (keloids).

Signs and Symptoms

The most common locations of acne keloidalis nuchae include:

• Back of the neck (posterior neck)
• Lower back of the scalp (occipital scalp)

Initially, lesions of acne keloidalis nuchae appear as red or pus-filled bumps, which may be tender or itchy. Over time, these inflamed bumps develop into small scars. Without treatment, the small scars can coalesce into large, thick scars, or keloids. Areas of widespread scarring may be associated with hair loss. Rarely, advanced acne keloidalis nuchae lesions can develop deep pockets of pus with connections to the surface of the skin, and a foul-smelling discharge may ooze from these sinus tracts.

People who develop acne keloidalis nuchae should focus on avoiding irritation to the area in order to prevent the formation of additional lesions:

• Wash the area gently with non-irritating cleansers (no hard scrubbing!).
• Avoid head wear (such as sports helmets) and shirt collars that rub against the back of your neck.
• Avoid closely shaving of the back of your neck.
• For itchy lesions, try an over-the-counter cortisone cream.

Generally, persons with acne keloidalis nuchae should see their primary care doctor or a dermatologist for treatment in order to prevent progression of the condition.

If you suspect you have acne keloidalis nuchae, you should seek help from your primary care provider or a dermatologist in order to prevent the possible formation of large scars and permanent hair loss to the involved areas.

Topical corticosteroids may produce perioral dermatitis, a localized erythematous papular or pustular eruption.5
Endocrine causes of acne include Cushing’s disease or syndrome, polycystic ovary syndrome, and congenital adrenal hyperplasia.6 Clinical clues to possible hyperandrogenism in women include dysmenorrhea, virilization (i.e., hirsutism, clitoromegaly, temporal balding), and severe acne.

Acne Cheloidalis Nuchae

Treatments Your Provider May Prescribe

The prognosis of acne keloidalis nuchae is good if treatment is started early.

Topical creams, lotions, or gels may include:

• A retinoid cream such as tretinoin, tazarotene, or adapalene.
• A prescription-strength steroid or cortisone preparation.
• An antibiotic such as clindamycin.

Oral medications may include:

• Antibiotic pills.
• A short course of steroids, such as prednisone (for severe or advanced cases only).

Procedures to reduce inflammation and reduce or remove scar tissue include:

• Steroid injections directly into the inflamed bumps or scars.
• Surgical excision of single bumps or larger scars.
• Laser destruction.
• Liquid nitrogen (freezing or cryotherapy).

Acne Keloidalis Nuchae in depth article by Philip R Letada, MD, and Elizabeth Kline Satter, MD, MPH

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