Acne Keloidalis Nuchae with Tufted Hair Folliculitis in a 42-year-old Male: A Case Report

Authors: Lisa Denise A. Encarnacion, MD, Dell Kristie O. Castillejos, MD FPDS, Claudine Y. Silva, MD, FPDS

Abstract

Introduction: Acne Keloidalis Nuchae (AKN) is a chronic disorder involving inflammation and scarring of hair follicles with subsequent development of keloid-like papules and plaques commonly affecting the occipital scalp. Tufted Hair Folliculitis (THF) is a rare and progressive inflammatory condition of the scalp characterized by peculiar tufting of hair. Several authors suggest THF is a secondary phenomenon occurring in inflammatory scalp disorders, including Dissecting Cellulitis, Acne Keloidalis Nuchae, and Folliculitis Decalvans.

Case Summary: This is a case of a 42-year-old male presenting with multiple dusky red papules and skin-colored keloidal plaques with tufts of hair on the scalp. Lesions were first noted 4 years prior, beginning as a solitary, erythematous, asymptomatic papule on the left vertex of the scalp with no associated trauma. Biopsy showed dense perifollicular mixed infiltrates and marked dermal fibrosis consistent with Acne Keloidalis Nuchae. Patient was advised to undergo monthly intralesional steroid injection and to start oral Doxycycline 100mg/tab once daily.

Conclusion: Acne Keloidalis Nuchae is a primary scarring alopecia resulting from follicular damage sufficient to cause destruction and replacement of pilosebaceous structures by scar tissue. Tufted Hair Folliculitis is an inflammatory polytrichia regarded as a secondary phenomenon of primary scarring alopecias. Clinical presentation of AKN involves variable degrees of inflammation and scarring on the posterior lower scalp and nape, with pink to dusky red papules or plaques, later with tufts of hair. Biopsy shows dense perifollicular mixed infiltrates and dermal fibrosis. Treatment consists of intralesional steroid injection and oral Tetracyclines with or without topical retinoids.

 

Citation

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Keywords

acne keloidalis nuchae, tufted hair folliculitis, scarring alopecia

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