Acne keloidalis nuchae

Acne keloidalis nuchae Definition

It is a severe form of folliculitis, a condition manifested by infection and inflammation of the hair follicles, which may occur on the occipital scalp and posterior neck. It is abbreviated as AKN. The disorder is also known by the following names:

  • Nuchal keloid acne

  • Dermatitis papillaris capillitii

  • Folliculitis keloidis nuchae

  • Folliculitis keloidalis

Acne keloidalis nuchae Incidence

It is highly prevalent in Africans Americans and affects only males since they trim their hair short. AKN is normally observed in persons aged 13-25 years.

Acne keloidalis nuchae Symptoms

The early phase of AKN is marked by rigid, bulge-shaped, follicular-based papules that measure 2- 4 mm in diameter. As aforementioned, the papules are localized to the occipital region of the scalp and the nape of the neck. Many patients develop pustules or eroded blisters as a result of trauma or itching. This is most likely to happen when someone brushes the hair. In the later stages, bigger plaques are formed when the papules and pustules merge together. In severe cases, broken hairs appear at the periphery of the plaques. These scaly patches measure greater than 10 cm in diameter. Most patients gradually develop scars on the affected regions that lead to partial or complete hair loss. Folliculitis keloidalis-affected patients may develop abscesses that are prone to exudation.

Acne keloidalis nuchae Causes

Swelling of the hair follicles can be caused by friction from clothing, follicle blockage, insect bite, close shaving, or tight braids. Bacteria like Pseudomonas aeruginosa and Staphylococcus aureas feed on these damaged follicles and cause infection. A number of fungal and viral agents are also responsible for aggravating the condition. In some cases, AKN could result from iron deficiency anemia. Shirt collars and athletic gears can cause irritation and pruning of the hairs. Autoimmune disorders are often linked to AKN. Administration of cyclosporine or anti-epileptic drugs can trigger inflammation of the hair follicles. Some of the other conditions linked to AKN include:

  • Cancer

  • Oil folliculitis

  • Folliculitis decalvans

  • Folliculitis keloidalis

  • Pseudofolliculitis barbae

  • Eosinophilic folliculitis

Acne keloidalis nuchae Diagnosis

Bacterial or fungal culture of the papules may help in identifying the underlying cause. A skin biopsy is essential to exclude the possibility of other conditions.

Acne keloidalis nuchae Differential Diagnosis

AKN must be distinguished from the following conditions during diagnosis:

  • Perifolliculitis Capitis Abscedens et Suffodiens

  • Hidradenitis Suppurativa

  • Acne Vulgaris

  • Acneiform Eruptions

  • Acne Conglobata

Acne keloidalis nuchae Histology

Histologic findings reveal infiltrating cells composed of neutrophils and lymphocytes around the lower infundibulum and isthmus of the hair follicle. The follicles and sebaceous glands are damaged with discharge of hair shafts into the dermis. Granulomatous inflammation of the free hair shafts is clearly visible. Dermal fibrosis is also seen.

Acne keloidalis nuchae Neck

Acne keloidalis nuchae Treatment

Application of benzoyl peroxide, mild keratolytic cleansers, chlorhexidine and alpha-hydroxy acids on the lesions can prevent cosmetic disfigurement. Use of topical antiseptics and antibiotics such as mupirocin or neomycin can ameliorate the growth of papules. High dose of topical steroids are also effective. In few cases, healthcare givers give a short course of oral corticosteroids. Use of isotretinoin can prevent the progression of the disorder. In order to reduce the size of the elevated growths, triamcinolone acetonide is directly injected into the lesions. Use of liquid nitrogen and lidocaine cream eases the injection process. Immunotherapy and intralesional 5-fluorouracil also promote remission of the abnormal skin growths. The lesions can be removed to a greater extent by cryotherapy and radiation therapy. As a part of natural treatment, a mild, alcohol-free non-abrasive cleanser can be used over the affected area.

Acne keloidalis nuchae Pictures

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References

http://en.wikipedia.org/wiki/Acne_keloidalis_nuchae

http://emedicine.medscape.com/article/1072149-overview#a0199

http://www.dermnet.org.nz/pathology/acne-keloidalis-nuchae-path.html

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