Acne Keloidalis Nuchae

What is Acne Keloidalis Nuchae?

Acne keloidalis nuchae is a form of acne characterized by very painful and destructive scarring on the scalp. It is a form of folliculitis; that is, it is a product of swollen hair follicles. Acne keloidalis nuchae almost exclusively affects men of African descent, although the reasons for this are not prevailingly clear. It is thought that this statistic holds because men of African descent are genetically prone to tightly curled coarse hair that they keep cut short (whereas women are generally more likely to have longer hair). Because the hair is cut short and curls, it is thought to curl in on the skin of the scalp, causing irritation, the subsequent swelling of follicles, lesions, and ultimately keloid-like scarring.

Notable, acne keloidalis nuchae is not an offshoot of acne vulgaris, nor is it truly keloid in nature. While the name is a misnomer it is still held in the same esteem and categorization of most other chronic acne conditions.

Acne keloidalis nuchae forms almost exclusively on the occipital scalp (that is, the back of the head) and the nape of the neck. It only rarely appears elsewhere on the scalp.

Who gets Acne Keloidalis Nuchae?

Acne keloidalis nuchae almost solely affects men of African descent. The reasons for this are not clearly understood. Acne keloidalis nuchae is not inherited as a genetic trait, as some other ailments do. Sickle cell anemia, for instance, is found exclusively in individuals with some African heritage, and is passed on genetically, but acne keloidalis nuchae is not passed on in the same way.

The primary school of thought regarding the incidence of acne keloidalis nuchae is that it results from hair growth. Individuals of African descent frequently have tightly curled, coarse hair. When this is cropped very short or shaved, it may curl inward as it grows back, causing it to needle into and through the skin of the scalp, inflaming the follicles and leaving the skin prone to infection. The thinking follows that the sex disparity noted occurs so because men are more likely to have short hair than women.

It should be noted that this demographic is not fully proven or understood. Individuals have been reported with cases of acne keloidalis nuchae that were female, and individuals have been reported with cases of acne keloidalis nuchae that were not of African descent.

It most frequently afflicts adolescents and young adults between the ages of 13 and 25. It is possible for acne keloidalis nuchae to manifest later in life, but this is rare and considered highly unusual.

What causes Acne Keloidalis Nuchae?

It is thought that acne keloidalis nuchae results from the in-growth of tightly curled coarse hairs. It primarily afflicts men of African descent, who are more likely to have tightly curled, coarse hair, and are more likely to crop this hair very close to the skin. The curling-in of the hair causes incredible irritation of the scalp, intense folliculitis, and subsequently, the signature keloid-like scarring. Simply cutting the hair short is not usually an issue, but short-shaved hair is: the tips of the hair must be very close to the skin for them to become ingrown, much in the same way that simply trimming a beard will not cause ingrown hairs, but shaving it may. Notably, factors that contribute to acne vulgaris, like hormonal imbalances, exposure to chemicals, overactive sebaceous glands and etcetera will not impact acne keloidalis nuchae. Furthermore, conditions related to keloid-type ailments will also not apply, as acne keloidalis nuchae is not a truly keloidal affliction.

Bacterial infection is a possible cause or concurrent cause of acne keloidalis nuchae, and antibiotics may be prescribed to deal with an infection if symptoms present.

Certain clothing, particularly collars, and certain components of sports equipment may irritate the skin and cause the hair to shear, which might be thought of as the hair fraying.

What does Acne Keloidalis Nuchae cause?

Acne keloidalis nuchae by definition causes severe, painful and permanent scarring. It is a chronic, self-perpetuating condition. These scars can be disfiguring, and generally prevent any hair growth where they have form. Hair that does grow where the keloid-like scars have formed tends to be tufted, broken or ingrown. Acne keloidalis nuchae is very irritating and, furthermore, gets much worse if it is excoriated, making scratching a very bad idea.

How serious is Acne Keloidalis Nuchae?

Acne keloidalis nuchae is a serious, chronic condition. It is never fatal, and the keloid-like scarifications are themselves entirely benign. Even so, it is very, very uncomfortable, and can interfere with all aspects of life simply by being a persistent, unflinching distraction. The psychological impact of extensive acne keloidalis nuchae can be very heavy. It may not abate without treatment once it has begun, and may frequently require the intervention of a dermatologist.

What does Acne Keloidalis Nuchae treatment look like?

Acne keloidalis nuchae treatment involves, first, removing the source of the irritation. The individual suffering should stop shaving their hair close, and should avoid seeing the site irritated further with collars, sports equipment, or anything else that might cause mechanical exacerbation of the condition. Treatment generally comes in the form of a gently acidic benzoyl peroxide shampoo, or a similar foaming formulation with similar effects.

Crusting or oozing of the papules may indicate a bacterial infection. In this instance, topical antibiotics will be prescribed to eliminate the presence of any bacteria. If or when improvement is not noted over the course of this therapy, a culture of the bacteria may be analyzed to determine the nature of the infection and better tailor the course of antibiotics.

How do I know if I have Acne Keloidalis Nuchae?

Acne keloidalis nuchae is characterized by the severe irritation of the scalp culminating in painful papules. These papules, over time, grow more irritated and eventually begin to scar. Said pustules may eventually abscess or begin oozing. If these symptoms seem to culminate with shaving one’s head, and in-grown hairs seem to be the source of this irritation, contact a physician immediately. The earlier the condition can be treated and slowed, the less likely any permanent scarring is, and the faster the irritation can end.

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