Clive Anderson - AT THE DERMATOLOGISTACNE KELOIDALIS is the name given to a condition, which presents with firm acne-like bumps at the nape. The condition occurs in black males almost exclusively but has been seen to occur in black women also. The male to female ratio is estimated at 20:1. Often the bumps first appear at the back of the neck in early adulthood, but cases during adolescence are not rare.
The eruption starts as small papules at the hair line which slowly increase in size. The patient may complain of itching and occasionally the bumps become pus filled and tender. If untreated the lesions grow bigger at a slow pace, forming large scar-like plaques which may grow into each other as a large dome- shaped patch.
The exact cause of these bumps is still unknown. Precipitating factors are thought to be injury to the skin from shaving or cutting the hair low at the back of the neck. Ingrown hairs are thought to play a role as well. Some authorities suggest that constant irritation from shirt collars may also be a trigger.
Microscopic studies of the skin affected by acne keloidalis indicate that the hair follicles are weakened, allowing the hair shafts to penetrate the dermis of the skin. To the skin this 'naked' hair shaft is a foreign body like a prickle. The skin tries to engulf the invader, forming a bump around it and laying down scar tissue around it. Infection from barbering implements does not seem to play a role in causing the bumps.
Acne keloidalis is a benign condition, medically, but causes severe psychosocial trauma to sufferers. Chronic itching, scarring and purulent discharge may occur. Often hair growth in the area is lost to the severe embarrassment of the sufferer.
This condition requires early and persistent treatment in order to prevent the small bumps developing into large scars. The first line of attack is prevention:
Persons with this problem should avoid cutting the hair low at the back of the head.
Do not edge the hairline at the nape. Avoid tight-fitting shirts or other clothing that may cause irritation at the back of the neck.
Treat the existing lesions early.
There is no magic bullet for acne keloidalis. Treatment is often slow and lengthy.
Early treatment with a topical steroid and antibiotic is often successful in flattening the bumps. When pustules and crusts are present oral antibiotics may be necessary.
Topical retinoids compounds used to treat acne, are often used to flatten the lesions. Some Dermatologists use a combination of these preparations to achieve success in the management of this chronic condition.
Intralesional steroids or injections of a steroid into the larger lesions are sometimes necessary.
Laser therapy is successful in some patients.
In resistant cases surgical removal of individual lesions using a punch is the next option. Larger lesions are excised surgically, using a deep incision.
Like most medical conditions the key to success is not to ignore the lesions, for they rarely go away on their own. See a dermatologist early.
Dr. Clive Anderson is a Dermatologist and Venereologist.
