acne keloidalis nuchae; folliculitis keloidalis

Epidemiology

• people of skin color

Clinical manifestations

• firm, skin-colored, pink or hyperpigmented papules centered on hair follicles in people of color

* images

Management

• no good treatment
• patient education
  • mechanical shearing of the hairs exacerbates
    • short haircuts & close shaving
    • tight-fitting collared shirts, athletic head gear
    • manual manipulation
• topical antimicrobial cleaners/shampoos
  • foaming benzoyl peroxide washes or chlorhexidine may help prevent secondary infection
  • tar shampoos may be alternative
• mild keratolytic agents containing alpha-hydroxy acids or topical retinoids may help soften coarse hairs
• topical retinoids appear to be more effective than potent topical glucocorticoids
• treat infection (topical clindamycin)
• intralesional triamcinolone (5-40 mg/mL) can reduce size of papules & nodules
• ultraviolet B (290-320nm) phototherapy, 3x/week for 8 weeks may improve appearance of fibrotic papules
• cryotherapy may be helpful
  • treated site often becomes hypopigmented
• short course of oral glucocorticoids for large inflamed lesions
• surgery
  • laser ablation for refractory cases
  • surgical excision needs to remove entire hair follicle
    • when closing, ensure patient's neck is not flexed

More general terms

• dermatitis

Additional terms

• pseudofolliculitis barbae; pili incarnati