Acne keloidalis

Question 1

What is the pathogenesis of acne keloidalis nuchae?

Answer 1

• chronic inflammatory condition
• unknown exactly how/why this occurs, could be mechanical (shaving, due to ingrown hairs, or could have hormonal role with males much more commonly affected)
• note these lesions are neither acne, nor true keloids

Question 2

How does acne keloidalis present?

Answer 2

• most commonly in african american males: pustules and keloid-like papules and plaques occur at the nape of the neck, occipital scalp, and sometimes extend up to the vertex scalp

Question 3

How do you treat acne keloidalis nuchae for mild, moderate and severe dz? Patient education?

Answer 3

• educate not to pick these areas, not to shave closely at barber, not to wear tight clothing or helmets that irritate
• mild: high potency topical steroids and tretinoin topically
• moderate: ILK injections q4weeks (warn dark skin patients about hypopigmentation that can occur), can also had BP wash and topical clindamycin lotion if appears infected
• severe: antibiotics if infected, isotret, surgical excision with ILK q3-4 weeks after