Search
acne keloidalis nuchae; folliculitis keloidalis
Epidemiology:
- people of skin color
Clinical manifestations:
- firm, skin-colored, pink or hyperpigmented papules centered on hair follicles in people of color [1]
* images [2,3]
Management:
- no good treatment [2]
- patient education
- mechanical shearing of the hairs exacerbates
- short haircuts & close shaving
- tight-fitting collared shirts, athletic head gear
- manual manipulation
- topical antimicrobial cleaners/shampoos
- foaming benzoyl peroxide washes or chlorhexidine may help prevent secondary infection
- tar shampoos may be alternative
- mild keratolytic agents containing alpha-hydroxy acids or topical retinoids may help soften coarse hairs
- topical retinoids appear to be more effective than potent topical glucocorticoids [2]
- treat infection (topical clindamycin)
- intralesional triamcinolone (5-40 mg/mL) can reduce size of papules & nodules
- ultraviolet B (290-320nm) phototherapy, 3x/week for 8 weeks may improve appearance of fibrotic papules
- cryotherapy may be helpful
- treated site often becomes hypopigmented
- short course of oral glucocorticoids for large inflamed lesions
- surgery
- laser ablation for refractory cases
- surgical excision needs to remove entire hair follicle
- when closing, ensure patient's neck is not flexed [2]
Related
pseudofolliculitis barbae; pili incarnati
General
dermatitis
References
- Medical Knowledge Self Assessment Program (MKSAP) 17,
American College of Physicians, Philadelphia 2015
- Satter EK, James WD (images)
Medscape: Acne Keloidalis Nuchae
http://emedicine.medscape.com/article/1072149-overview
- DermNet NZ. Folliculitis keloidalis (images)
http://www.dermnetnz.org/acne/keloid-acne.html