A 30-Year-Old Man of African Descent with Keloid-Like Plaques on the Nape of the Neck

Abstract

Acne keloidalis nuchae, also known as folliculitis keloidalis nuchae, is a recurrent chronic follicular inflammation subsequently resulting in scarring alopecia. The role of androgens, obesity and genetic predisposition is hypothesized. Ingrown hair, trauma, infections, close shave haircuts, friction from collars and helmets are suggested as trigger factors. Young man of African descent are most commonly affected. Clinically, acne keloidalis nuchae is characterized by the presence of single or multiple smooth dome-shaped, firm, follicular papules and pustules progressing to keloid–like plaques associated with hair loss. In chronic, recurrent disease abscesses and purulent fistulas may be observed. Lesions occur mainly on the neck and occipital area. Diagnosis of acne keloidalis nuchae is usually established based on the clinical picture. Management of acne keloidalis nuchae focuses on preventing the disease progression with avoidance of mechanical irritation and the use of antimicrobial cleansers to prevent secondary infection. Pharmacological therapy includes topical and intralesional corticosteroids, topical and systemic antibiotics and retinoids. Severe and recalcitrant lesions may be amenable to surgery with or without postsurgical radiotherapy, electro- and cryosurgeries and laser therapy.