HistoryThis section has been translated automatically.
DefinitionThis section has been translated automatically.
Eminently chronic fibrosing and indurating folliculitis and perifolliculitis of the neck region, leading to irreversible hair loss and progressive, extensive, bulging keloid scarring.
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EtiopathogenesisThis section has been translated automatically.
An initial staphylococcal folliculitis after short haircut or shaving is discussed. There is no pathogenetic relationship to acne (localization, absence of comedones). Due to an unknown cause, a transition into a chronic fibrosing inflammation with tissue hyperplasia and a reactive pressure atrophy of the follicles occurs.
ManifestationThis section has been translated automatically.
Occurring only in males. Onset after puberty. People with dark skin color are affected more often (peculiarities of the hair structure).
LocalizationThis section has been translated automatically.
Clinical featuresThis section has been translated automatically.
Initially individual, small, red, follicular papules and pustules, from which develop hard, dark red, hemispherical, shiny, differently sized, solid papules and nodules pierced by a terminal or vellus hair, which can confluent to form larger plate-like structures.
Later increasing sclerotic, almost board-like hardening of the skin between them.
Beam-like, transverse, coarse, bulging keloids with tufts of hair.
Deep epithelium-lined fistula ducts.
Peripheral continuous sometimes intermittent progression of the sclerosing inflammation over a period of years.
Differential diagnosisThis section has been translated automatically.
Furuncle: Highly painful, acute onset; originating from 1 follicle; no multiple pustules on the surface; markedly fluctuant.
Folliculitis decalvans: Eminently chronic course of the disease usually over years; scarring alopecia; highly red skin lesions in the center usually atrophic shiny and marginal standing follicular papules; later pustular transformation and crusting. Irregularly shaped foci of scarring with small-spotted, irreversible hair loss result. Formation of tufted hairs.
Tinea capitis profunda: Mostly occurring in children! Subacute or acute course; itchy or moderately painful, 0.5-5.0 cm in size, usually well demarcated, cushion-like raised, purulent, bright red plaques or nodules. Pus may be discharged on pressure. Hairs are absent from the lesion; hairs that still exist can be easily and usually painlessly extracted; preparation of a native specimen for fungal detection.
TherapyThis section has been translated automatically.
Intralesional injections with glucocorticoids such as triamcinolone acetonide (e.g. Volon A 10 crystal suspension) diluted 1:3 to 1:5 with physiological NaCl solution or local anesthetic such as mepivacaine, several times at intervals of weeks.
In inflammatory phases, if necessary, local disinfecting solutions polihexanide (Serasept, Prontoderm), polyvidone-iodine solution (e.g. Betaisodona) or corticoid-containing preparations with antimicrobial component (e.g. InfectoCortiSept®).
Excise small foci en bloc, cover larger ones after excision plastically by full-thickness skin graft or stretch plastic.
Attempt treatment with tetracyclines (e.g. Tetracycline Wolff) 4 times/day 250 mg p.o. or with isotretinoin (e.g. Isotretinoin-ratiopharm; Aknenormin) 0.5 mg/kg bw/day p.o. Caution! Women of childbearing age!
Progression/forecastThis section has been translated automatically.
LiteratureThis section has been translated automatically.
- Adamson HG (1914) Dermatitis papillaris capillittii (Kaposi). Acne keloid. Br J Dermatol 26: 69-83
- Alexis A et al (2014) Folliculitis keloidalis nuchae and pseudofolliculitis barbae: are prevention and effective treatment within reach? Dermatol Clin 32:183-191
- Gloster HM Jr (2000) The surgical management of extensive cases of acne keloidalis nuchae. Arch Dermatol 136: 1376-1379
- Hebra v. F, Kaposi M (1860) Textbook on skin diseases. Enke, Erlangen, vol. 1, p. 506
- Kaposi M (1894) On some unusual forms of acne (folliculitis). Arch Dermatol Syph 26: 87-96
- Kelly AP (2003) Pseudofolliculitis barbae and acne keloidalis nuchae. Dermatol Clin 21: 645-653
- Sparrow LC (2000) Acne keloidalis is a form of primary scarring alopecia. Arch Dermatol 136: 479-484
Shapero J et al (2011) Acne keloidalis nuchae is scar and keloid formation condary
to mechanically induced folliculitis. J Cutan Med Surg 15:238-240
Incoming links (10)Folliculite pilo-sebacée chronic; Folliculitis scleroticans nuchae; Keloidal folliculitis; Neck keloid; Papillary dermatitis capillitii; Perifolliculitis capitis abscedens et suffodiens; Sycosis framboesiformis; Sycosis nuchae sclerotisans; Tinea capitis profunda; Tuft hair;
Outgoing links (19)Acne (overview); Boils; Disinfectants; Excision; Folliculitis decalvans; Folliculitis (overview); Full skin grafts; Glucocorticosteroids systemic; Isotretinoin; Papel; ... Show all
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