Acne Keloidalis Nuchae: Causes, Symptoms, Diagnosis, and Treatment

Introduction:

Unlike its name, acne keloidalis nuchae is not a type of acne but rather a type of folliculitis (inflammation of the hair follicle). It is also called folliculitis keloidalis, acne cheloidalis nuchae, or acne keloidalis. Studies have shown that acne keloidalis has an association with metabolic syndrome and obesity.

What Is Acne Keloidais Nuchae?

Acne keloidalis nuchae is a chronic skin condition that primarily affects the back of the neck and occipital scalp area in individuals with tightly coiled hair. This skin condition begins with tiny, itchy bumps on the surface of the skin along the hairline. With time, these tiny bumps on the skin become scars, and the hair around them falls off. Eventually, the condition progresses to the formation of firm, raised papules and nodules that can progress to form tough, raised keloid-like scars. Additionally, secondary staphylococcal infections (bacterial infections) may cause pustules around the hair follicles, which may lead to alopecia (hair loss). Dermatologists diagnose the condition based on observing the skin condition and confirm the condition with microscopic findings (biopsies).

Who Is More Prone to Develop Acne Keloidalis Nuchae?

Individuals who are at a higher risk of developing acne keloidalis nuchae have a -

• A family history of skin conditions and disorders.

• Dark skin type.

• Short curly hair.

• High testosterone levels in the body.

• Dry and flaky skin type.

What Causes Acne Keloidalis Nuchae?

The condition is more common in men of African descent, but it can occur in people of any race or gender. The exact cause of acne keloidalis nuchae is unknown, but it is believed to be triggered by inflammation and irritation of the hair follicles that arise from -

• Injuries During Shaving - Acne keloidalis could occur from close shaving, which can cause skin irritation and inflammation, especially when using sharp razor blades. The sharp blades can also cause small cuts that may trigger acne keloidalis nuchae.

• Hair Ingrowth - Some medical professionals believe individuals with ingrown hair (hair growth that occurs inside the skin) irritate the lining of the hair follicles, causing inflammation of the skin.

• Skin Infections - Researches show long-term skin infections, existing infections, or underlying skin disorders can trigger the onset of acne keloidalis nuchae.

• Skin Irritations - People with sensitive skin are prone to skin irritations due to constant friction. For example, wearing collared shirts can irritate the skin at the back of the neck, triggering acne keloidalis nuchae. Other factors, like heat and sweat, can make the condition worse.

• Medications - Cyclosporine, which is a drug used to treat conditions like rheumatoid arthritis and skin conditions like psoriasis, and other antiepileptic drugs, could have side effects and trigger this condition.

• Genetics - Genetic conditions that include having a weak hair follicle can also trigger the onset of acne keloidalis nuchae.

How Is Acne Keloidalis Nuchae Treated?

Dermatologists often find it difficult to treat this condition, and hence different techniques are used for different individuals depending on the severity.

• Laser Therapy - Lasers and light therapy for skin conditions work to decrease inflammation and damage to the hair follicle. Along with laser therapy, doctors also prescribe topical creams, gels, and lotions containing steroids and retinoids for the desired results. Laser treatments require multiple sessions but give successful results for treating acne keloidalis nuchae. Laser vaporization and radiotherapy are other methods for treating acne keloidalis nuchae.

• Medications - Dermatologists often prescribe antibiotics like Clindamycin and Rifampicin for any skin infections if they are present and two to four weeks of topical steroids to reduce the papules on the skin. Oral corticosteroids are rarely prescribed in cases of large, inflamed lesions. At times, steroid injections may be given for larger papules and plaques.

• Surgeries - In severe conditions, when papules and scars are large enough to cause discomfort and also have the potential to spread on the skin, surgeries may be required.

• Skin biopsies are done where the skin tissues are removed (the skin is punctured, and the lesion is removed) and then stitched back together with anti-inflammatory medications to improve healing.

• Surgical excisions are performed to treat larger lesions.

• Electrosurgery is done to completely excise the lesion using a high-frequency electric current to cut the lesion.

• Cauterization (burning or freezing) treatments using liquid nitrogen are also done in cases where surgery is not favorable.

Are There Any Tips to Manage Acne Keloidalis?

Though certain products may not suit everyone, one can try using the following to manage the condition –

• Tar Shampoos - Keratoplastic shampoos, or tar shampoos, may be used to control the itchiness that arises due to acne keloidalis nuchae. These shampoos cause the shedding of the dead skin layers of the superficial skin and promote the growth of new cells, and prevent scaling of the skin.

• Antimicrobial Cleansers - The use of soaps that contain antimicrobial elements to prevent infections is important. One must avoid using soaps that cause too much lather, dryness, and itchiness. Soaps and cleaners containing Benzoyl peroxide or Chlorhexidine help relieve the symptoms.

• In the case of any reactions or unusual symptoms, one must consult a dermatologist at the earliest possible time.

What Should One Avoid Doing in Acne Keloidalis?

• One should avoid wearing helmets and collared t-shirts that rub and cause friction along the nape of the neck or along the hairline.

• One should avoid short haircuts, and the ends of the hair may irritate the skin and trigger the condition.

• The use of hair grease and oily skin care products must be avoided.

• Close shaving and the use of perfumes on the neck that causes skin irritation should be avoided.

• Individuals with sensitive skin should take extra precautions to keep the areas clean and dry. Avoid harsh exfoliation or rubbing too hard to clean the surfaces. Gentle cleansing using doctor-prescribed creams is recommended.

Conclusion:

Though acne keloidalis nuchae may not have a definite cure that works for all individuals, treatment options, including topical or oral medications, laser therapy, and surgical intervention, are proven methods to reduce the severity of the condition. Avoiding triggers, taking the necessary precautions, and using a combination of treatment therapies planned by a dermatologist can give results. Hence, it is important to maintain tropical hygiene and seek medical attention early to prevent the condition from worsening and causing permanent scarring.