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Acne Keloid

Acne Keloidalis Nuchae


Presentation

  • The more chronic presentation will demonstrate dense dermal fibrosis with chronic inflammatory cell infiltrate, which includes numerous plasma cells. Hair shafts surrounded by microabscesses and or foreign body giant cells are present in the dermis.[dermatologyadvisor.com]
  • Characteristically, comedones are not present in the affected area.[oatext.com]
  • Scarring is typically present in the time patients present for medical evaluation. Scarring is manifested by variable sized keloidal papules, plaques, or nodules at the site of previously involved hair follicles.[statpearls.com]
  • Conclusion: The pattern of acne keloidalis nuchae in Nigerians is similar to that reported in the western literature, except for significant proportion of males presenting at the fibrotic phase with massive keloids initially.[ajol.info]
  • It presents with small, smooth, firm bumps with occasional pus on the posterior scalp and nape of the neck.[docs4hair.com]
Weakness
  • A genetic mutation that increases someone’s chances of having weak hair follicle structure may play a role. Chronic infection. Chronic, low-grade infections may also play a role in the development of acne keloidalis nuchae.[healthline.com]
  • This single-nucleotide polymorphism predisposes patients for PFB since it is associated with structural weakness of the hair follicle. [11] Epidemiology Frequency Acne keloidalis nuchae (AKN) is said to represent 0.45% of all dermatoses affecting black[emedicine.medscape.com]
Acne Vulgaris
  • […] management and treatment of patients with acne vulgaris.[evidence.nhs.uk]
  • The term acne keloidalis nuchae is somewhat of a misnomer because the lesions do not occur as a result of acne vulgaris, but rather a folliculitis. Moreover, histologically lesions are not keloidal.[pcds.org.uk]
  • Although it is not related to common acne (acne vulgaris), acne keloidalis nuchae initially appears as acne-like lesions of inflamed hair follicles (folliculitis) on the nape of the neck (nuchal area) and, without treatment, can result in large scars[skinsight.com]
  • Vulgaris Keloid Folliculitis Acne Keloid Skin Diseases Acneiform Eruptions Sebaceous Gland Diseases Collagen Diseases Connective Tissue Diseases Cicatrix Fibrosis Pathologic Processes Hair Diseases Triamcinolone Triamcinolone Acetonide Triamcinolone[clinicaltrials.gov]
  • Unlike true acne vulgaris, comedones are not a common feature of AKN. [4] Pathophysiology The exact etiology of acne keloidalis nuchae (AKN) is unclear.[emedicine.medscape.com]
Excoriation
  • Acne vulgaris Acne vulgaris Last revised in April 2018 Next planned review by December 2023 Summary Back Lichen Simplex Lichen simplex, sometimes called neurodermatitis, presents as a localised demarcated plaque, usually with scaling, excoriations and[evidence.nhs.uk]
  • The persistent irritation and potential trauma from excoriation may initiate the AKN process in those with seborrheic dermatitis. The pathophysiologic mechanism responsible for acne keloidalis is analogous to that of pseudofolliculitis barbae.[dermatologyadvisor.com]
  • Crusting and excoriation may be evident [4]. In advanced or severe cases, disfiguring tumor-like masses, abscesses, and pus-exuding sinus tracts may be present [1,6]. Acne keloidalis nuchae is often asymptomatic.[oatext.com]
Acneiform Eruption
  • Acneiform eruptions occurred in 63.2% whilst the lesions were already fibotic with keloid-like papules/plaques in 76.3%.[ajol.info]
  • […] nuchae acne keloid keloidal folliculitis lichen keloidalis nuchae folliculitis nuchae scleroticans sycosis framboesiformis Additional relevant MeSH terms: Layout table for MeSH terms Dermatitis Acne Vulgaris Keloid Folliculitis Acne Keloid Skin Diseases Acneiform[clinicaltrials.gov]
Flushing
  • These soaks eventually flushed away the residual hemostatic powder as well as any persistent serous crust. Discussion Cold-steel excision is challenging due to often brisk bleeding associated with scalp incision.[the-dermatologist.com]
Withdrawn
  • The large plaques that occur also create poor body aesthetics and many males become withdrawn, shy, and depressed. Pruritus is common, and the constant scratching may lead to the breakdown of the papules and drainage.[statpearls.com]

Treatment

  • Keloid and Hypertrophic Scar Treatments Treatment for keloid and hypertrophic scarring comes in two stages, as it does for other acne scarring.[acnesupport.org.uk]
  • Traditional medical management can require months of daily treatment and may relapse after discontinuation of treatment [ 6 ].[ncbi.nlm.nih.gov]
  • A second treatment sitting with the above settings was repeated after 3 weeks, using the same laser applications on each side of the scalp as in the first treatment.[parjournal.net]
  • The treatment also causes hypopigmentation and often requires months of treatment. Surgical excision may be performed, but mild recurrences are not rare.[statpearls.com]
  • Physical therapies such as cryotherapy, ablative laser treatment and laser hair removal may also be considered. Surgical treatment or radiotherapy of the scarred area may be used for cases that are advanced or treatment resistant.[dermcoll.edu.au]

Prognosis

  • Treatments Your Physician May Prescribe The prognosis of acne keloidalis nuchae is good if treatment is started early. Topical creams, lotions, or gels may include: A retinoid cream such as tretinoin, tazarotene, or adapalene.[skinsight.com]
  • If acne keloidalis nuchae is diagnosed and treated early, the prognosis is good. However, once scarring has developed, the treatment is difficult, and most patients are left with a major cosmetic problem.[statpearls.com]
  • Lesions manifesting prior to puberty or in persons older than 50 years is unusual. [4, 9] Prognosis The prognosis is good if acne keloidalis nuchae (AKN) is treated early and properly.[emedicine.medscape.com]
  • Prognosis Keloids are harmless, cosmetic problems that do not become cancerous (malignant). Once a keloid stops growing, it usually remains stable unless the area is injured again.[drugs.com]
  • Prognosis Early lesions respond to medical treatment with minimal scarring. Surgical excision with healing with secondary intension tends to be effective in management.[dovepress.com]

Etiology

  • The definitive etiology of AKN is unknown. No specific genetic factor has been identified. In individuals with tightly curled hair, shaving or trimming the nape of the neck may initiate the presentation of AKN.[dermatologyadvisor.com]
  • The lesion occurs as a result of a folliculitis. [1] [2] [3] Etiology The exact etiology of acne keloidalis nuchae is unclear, but it might be triggered by chronic irritation or occlusion of the follicles due to hair cutting practices (e.g., close shaves[statpearls.com]
  • Post-Nd:YAG and -diode laser therapy; the lesion shows good resolution Discussion AKN has an unclear etiology, with a predominant occurrence in males.[parjournal.net]
  • Etiology of AKN Suggested etiologies include the following [1, 3, 4, 9, 12, 13, 14, 15, 16, 17] : Close shaving of the neck: This often exacerbates the condition. The sharp, curved hairs reenter the skin and invoke an acute inflammatory response.[emedicine.medscape.com]
  • Perceived etiological factors of folliculitis keloidalis nuchae and treatment options amongst Nigerian men. Br J Dermatol. 2015;173(Suppl 2):22–25. 7. Azurdia RM, Graham RM, Wesmann K, Guerin DM.[dovepress.com]

Epidemiology

  • Over time lesions result in scarring hair loss and keloid scars Epidemiology ( 6, 7, 8 ) FK is most common in men of African descent age 20-50 years, although it can also occur in women.[docs4hair.com]
  • Keloid acne of the neck: epidemiological studies over 10 years. Int J Dermatol 2005;44:49-50. George AO, Akanji AO. Clinical, biochemical, and morphologic features of acne keloidalis nuchae in a black population. Int J Dermatol 1993;32:714-6.[e-journal.unair.ac.id]
  • ., cyclosporine). [4] [5] Epidemiology Individuals with darkly pigmented skin, especially African Americans, are more prone to developing acne keloidalis nuchae.[statpearls.com]
  • This review highlights the epidemiology, clinical features, impact, and treatment challenges. Epidemiology AKN occurs majorly in those of African descent.[dovepress.com]
  • Keloid acne of the neck: epidemiological studies over 10 years. Int J Dermatol. 2005 Oct. 44 Suppl 1:49-50. [Medline]. Quarles FN, Brody H, Badreshia S, et al. Acne keloidalis nuchae. Dermatol Ther. 2007 May-Jun. 20(3):128-32. [Medline]. Kelly AP.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • These two cases reinforce the hypothesis that androgens have a role to play in the pathophysiology of KAN in its rare manifestations in females.[ibimapublishing.com]
  • Pathophysiology The repeated friction, trauma, and infection of the skin overlying the nape of the neck leads to acne keloidalis nuchae.[statpearls.com]
  • The pathophysiologic mechanism responsible for acne keloidalis is analogous to that of pseudofolliculitis barbae. Basically, it represents a foreign-body reaction as a result of the hair penetrating the dermis.[dermatologyadvisor.com]
  • AKN appears similar to keloids, yet there are differences in pathophysiology. These two cases highlight a surgical treatment course for AKN that plastic surgeons can incorporate into their practice.[longdom.org]
  • Unlike true acne vulgaris, comedones are not a common feature of AKN. [4] Pathophysiology The exact etiology of acne keloidalis nuchae (AKN) is unclear.[emedicine.medscape.com]

Prevention

  • Unfortunately, to prevent regrowth they need to be cut out widely and deeply. They heal best if left open, which can take weeks to months. Intralesional steroid injections or radiation treatment after surgery helps prevent recurrence of the AKN.[aocd.org]
  • Generally, persons with acne keloidalis nuchae should see their primary care doctor or a dermatologist for treatment in order to prevent progression of the condition.[skinsight.com]
  • Advanced treatments include removal of the scar by surgery, which can be followed by radiotherapy to prevent recurrence. Further information is available from the British Skin Foundation website.”[standard.co.uk]
  • As part of your treatment, your doctor may recommend certain over-the-counter products to help prevent the acne keloidalis nuchae from getting worse.[healthline.com]
  • The use of antiseptic or tar containing shampoos may be useful in preventing secondary bacterial infections at this stage.[dovepress.com]

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