Acne keloidalis nuchae L73.0

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

acne keloidalis; Acne sclerotisans nuchae; Folliculite pilo-sebacée chronic; Folliculitis nuchae sclerotisans; Folliculitis scleroticans nuchae; keloidal folliculitis; Neck Keloid; papillary dermatitis capillitii (Kaposi); sycosis framboesiformis (Hebra); Sycosis nuchae sclerotisans

History
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Hebra and Kaposi, 1860

Definition
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Eminently chronic fibrosing and indurating folliculitis and perifolliculitis of the neck region, leading to irreversible hair loss and progressive, extensive, bulging keloid scarring.

Etiopathogenesis
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Etio: discussed is an initial staphylococcal folliculitis after short haircut or shaving. There is no pathogenetic relationship to acne (localization, absence of comedones). From unknown cause transition to a chronic fibrosing process with tissue hyperplasia and pressure atrophy of the follicles.

Manifestation
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Occurs only in men, after the age of puberty; preferred in people with dark skin.

Localization
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Neck, neck hairline, possible extension to the back of the head.

Clinical features
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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 diagnosis
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  • Boils: Highly painful, acute; starting from 1 follicle; no multiple pustules on the surface; clearly fluctuating.
  • Folliculitis decalvans: Eminently chronic course of the disease mostly over years; scarred alopecia; highly red skin changes in the centre mostly atrophic shiny and peripheral follicular papules; later pustular transformation and crust formation. Irregularly shaped scar foci with small spots of irreversible hair loss result. Formation of tuft hairs.
  • Tinea capitis profunda: Mostly occurring in children! Subacute or acute course; itchy or moderately painful, 0.5-5.0 cm large, usually well defined, cushion-like raised, purulent, highly red plaques or nodules. Pus can be emptied under pressure. Hair is missing in the lesion; existing hair can be easily and usually painlessly extracted; preparation of a native preparation for fungal detection.

Therapy
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Progression/forecast
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Chronic recurrent course.

Literature
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  1. Adamson HG (1914) Dermatitis papillaris capillittii (Kaposi). Acne keloid. Br J Dermatol 26: 69-83
  2. Alexis A et al (2014) Folliculitis keloidalis nuchae and pseudofolliculitis barbae: are prevention and effective treatment within reach? Dermatol Clin 32:183-191
  3. Gloster HM Jr (2000) The surgical management of extensive cases of acne keloidalis nuchae. Arch Dermatol 136: 1376-1379
  4. Hebra v. F, Kaposi M (1860) Textbook on skin diseases. Enke, Erlangen, vol. 1, p. 506
  5. Kaposi M (1894) On some unusual forms of acne (folliculitis). Arch Dermatol Syph 26: 87-96
  6. Kelly AP (2003) Pseudofolliculitis barbae and acne keloidalis nuchae. Dermatol Clin 21: 645-653
  7. Sparrow LC (2000) Acne keloidalis is a form of primary scarring alopecia. Arch Dermatol 136: 479-484
  8. 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

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Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020