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Chapter 25: Acne Keloidalis Nuchae

INTRODUCTION

KEY POINTS

  • Acne keloidalis nuchae is a chronic folliculitis on the occipital neck that tends to predominantly affect men of color with coarse, curly hair.

  • In early stages, it can present with papules of variable size and color ranging from pink to pink-brown in lighter skin and brown to dark brown in darker skin. Pustules may be observed in more active disease.

  • In late stages, it can present with numerous and large keloidal plaques and postinflammatory pigmentation alteration.

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FIGURE 25-1.

Perifollicular clustered pink papules and pustules on the neck of a young Hispanic man. (From Usatine RP, Smith MA, Mayeaux EJ Jr, et al. The Color Atlas and Synopsis of Family Medicine, 3rd ed. New York, NY: McGraw Hill; 2019, Figure 123-5. Reproduced with permission from Richard P. Usatine, MD.)

A photo shows mid-sized, reddish, bulbous papules on the neck of a man.
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FIGURE 25-2.

Perifollicular pink-brown and skin-colored papules clustered on the occipital scalp, signifying earlier stage disease. (Reproduced with permission from Taylor SC, Kelly AP, Lim HW, et al. Taylor and Kelly’s Dermatology for Skin of Color, 2nd ed. New York, NY: McGraw Hill; 2016, Figure 34-2.)

A patient with brown skin with a cluster of pinkish and skin colored papules along the hairline on the occipital scalp.
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FIGURE 25-3.

Small, pink, clustered perifollicular papules on the occipital scalp of a light-skinned person. (Reproduced with permission from Ali A. McGraw-Hill Education Specialty Board Review Dermatology: A Pictorial Review, 3rd ed. New York, NY: McGraw Hill; 2015, Figure 1-19.)

The back scalp of a patient with acne keloidalis shows short, sparse hair with small and large pink annular papules spreading down the neck.
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FIGURE 25-4.

Pink and violaceous perifollicular papules, some distinct and others coalescing into small keloidal plaques on the occipital scalp of a dark-skinned man. (Reproduced with permission from Soutor C, Hordinsky MK. Clinical Dermatology. New York, NY: McGraw Hill; 2013, Figure 19-14.)

A patient with light brown skin with a cluster of light pink to purple papules along the hairline on the occipital scalp. Some of the papules have formed on top of each other forming keloidal plaques.
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FIGURE 25-5.

Large coalescing dark-brown to skin-colored keloids on the occipital scalp secondary to acne keloidalis nuchae. (Reproduced with permission from Taylor SC, Kelly AP, Lim HW, et al. Taylor and Kelly’s Dermatology for Skin of Color, 2nd ed. New York, NY: McGraw Hill; 2016, Figure 34-7.)

A patient with large sized, fused, light brown, thick, raised scar tissue on the back of the head.
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FIGURE 25-6.

Numerous skin-colored and pink-brown papules on the occipital scalp in a Black male with active acne keloidalis nuchae. (Reproduced with permission from Taylor SC, Kelly AP, Lim HW, et al. Taylor and Kelly’s Dermatology for Skin of Color, 2nd ed. New York, NY: McGraw Hill; 2016, Figure 34-3.)

A patient light brown skin with scattered pink to red papules along the hairline on the occipital scalp. Each papule is on a reddened background. There is significant hair loss in the area.
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