Acne Keloidalis Nuchae

Acne keloidalis nuchae is a chronic inflammatory process involving the hair follicles on the occipital scalp and nape of neck, leading to the formation of keloidal papules and plaques. The condition is most prevalent in men of African descent with Afro-textured hair. Most cases occur in patients 14 to 25 years. The male to female ratio is approximately 20:1. Clinically, affected patients present with variable degrees of inflammation and keloid-like lesions at the nape of the neck and occipital scalp. Initial lesions consist of small, smooth, firm, discrete, dome-shaped, follicular papules with or without pustules. Over time, the papules may coalesce to form hairless, keloid-like plaques/nodules, that may be fringed with tufted hairs. The condition is often asymptomatic. The patient should be counseled to wear soft or no-collar skirts, avoid short haircuts, avoid picking/rubbing/scratching the affected area, and avoid wearing tight-fitting hats/helmet. Mild to moderate cases can be treated with potent or ultra-potent topical corticosteroids alone or in combination with topical antibacterials or topical retinoids. Intralesional corticosteroids should be considered for resistant cases and for the treatment of keloidal scarring. Laser therapy should be considered for hair removal and/or softening of keloidal plaques. If pustules and draining sinuses are present, oral antibiotics should be used in addition to topical antibiotics. Surgical excision is the cornerstone of management for extensive plaques and tumor-like masses. Correspondence to: Dr. Alexander K.C. Leung, Clinical Professor of Pediatrics, University of Calgary, Pediatric Consultant, Alberta Children’s Hospital, #200, 233 – 16th Avenue NW, Calgary, Alberta, Canada T2M 0H5, Tel: (403) 2303322; E-mail: [email protected]