Acne keloidalis nuchae, sometimes called "acne keloiditis," or "folliculitis keloidalis nuchae," is a skin condition that affects the back of the neck and scalp. Without treatment, the bumps associated with this disease can sometimes become painful and develop into large scars known as keloids and permanent hair loss. Although the process isn't completely known, it can be associated with irritation from shaving, infection or an immune system disorder.
Who's at Risk
Acne keloidalis nuchae affects males of African descent most frequently, although it sometimes is found in men of Latino or Asian descent, and is rare in women. It tends to start when patients are in their twenties and is associated with stiff or curly hair, which tends to form ingrown hairs. There may be a genetic predisposition for the condition which is related to chronic and deep folliculitis, says Minneapolis dermatologist Charles E. Crutchfield, III. It is also more common with men who visit unlicensed barbershops where clippers and edgers are not properly sanitized. A 1997 study published in "Plastic Reconstruction Surgery" reported that elevated levels of testosterone were found in keloid scars, leading to the hypothesis that testosterone may contribute to the formation of the scars.
Symptoms
Although the terms are sometimes used interchangeably, "acne keloiditis" refers to the condition in which the skin is inflamed and pustular and "acne keloidalis" refers to skin that is inflamed and scarred. At first, the lesions appear as pea-sized red or pus-filled bumps, close to the hairline at the back of the neck, which may be itchy or tender and may bleed, especially during sleep or after showering.
Treatments
If treatment is started right away when symptoms first appear, the prognosis for acne keloidalis nuchae is good. The infection involved is treated with topical creams, lotions or gels that include tretinoin, tazarotene or adapalene, or one containing a prescription-strength steroid or cortisone. A 3-month course of oral antibiotics such as clindamycin and rifampicin may also be used, and in more severe cases, an oral steroid such as prednisone is added, according to the New Zealand Dermatological Society.
If the bumps have progressed to the keloid stage, then surgery, laser treatments or cryotherapy---where the tissue is frozen off---may be required. The American Osteopathic College of Dermatology and Yale School of Medicine add that steroid injections or low-dose radiation treatment after surgery can help prevent a recurrence of the condition.
Self Care
To avoid further irritating the affected area, wash gently with non-irritating cleansers, avoid shaving the back of your neck and avoid wearing any head gear or clothing that rubs against the neck, according to the doctors with Skinsight. For itchy lesions, you can try an over-the-counter hydrocortisone cream. You should avoid hair oils and greasy skin products and forego the shaved-head look, instead allowing your hair to grow long in the neck area.
Warnings
If you suspect you have this condition, you should always see a doctor for further treatment to avoid potential scars and permanent hair loss. The earlier you seek treatment, the better, since the condition can persist for many years. Avoid scratching, rubbing or picking at the bumps at all costs, or you could make the condition much worse.
