Folliculitis keloidalis

Folliculitis keloidalis (also called acne cheloidalis nuchae, and acne keloidalis) is an unusual skin condition affecting the nape of the neck. It commonly affects adult Afro-Caribbean males with curly hair and other dark-skinned individuals, but it can occur in any individual. The condition may persist for many years.

Folliculitis keloidalis

	Before treatment	After prolonged antibiotics

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Clinical features

Initially, itchy round small bumps appear within or close to the hair-bearing area of the back of the neck (occipital scalp). Sometimes there are pustules around the hair follicles (folliculitis). As time goes on the bumps become small scars and then the small scars may greatly enlarge to become keloids. The scars are hairless and can form a band along the hairline.

The cause of folliculitis keloidalis nuchae is not known. It may be a form of dermatitis or a form of acne. In most cases there are ingrown hairs which irritate the wall of the hair follicle resulting in inflammation.

An association with obesity and metabolic syndrome has been observed in some patients.

Treatment

Unfortunately folliculitis keloidalis often persists despite a variety of treatments. The following measures are sometimes helpful:

• Make sure clothing does not rub the back of the neck
• Oral tetracycline or antibiotics for secondary infection
• Three-month course of clindamycin and rifampicin antibiotics
• Topical steroids
• Steroids injected into the lesions (intralesional injections)
• Oral isotretinoin
• Radiotherapy
• Surgery (ie surgically removing all the affected skin)
• Laser excision or vaporisation