Primary nonessential cutis verticis gyrata with acne keloidalis nuchae.

Cutis verticis gyrata is a rare disorder characterized by redundant skin forming deep furrows and convolutions. It has been associated with several systemic and cutaneous disorders. We report a case of primary non-essential cutis verticis gyrata in association with acne keloidalis nuchae in a schizophrenic patient.

Hidradenitis suppurativa is associated with acne keloidalis nuchae: a population-based study.

The association between acne keloidalis nuchae (AKN) and hidradenitis suppurativa (HS) is yet to be investigated. To determine the link between AKN and HS using a large computerized health maintenance database. A cross-sectional study design was used to assess the prevalence of HS in patients with AKN and in control participants matched by age, sex, and ethnicity. A total of 2677 participants with AKN and 13,190 control participants were studied. An increased prevalence of HS was observed in the AKN group compared to the control group (1.0% vs. 0.3%, respectively; OR, 3.6; 95% CI 2.2-5.8; P < 0.001), especially among those younger than 20 years (OR, 10.2; 95% CI 3.1-34.2; P < 0.001), and females (OR, 15.7; 95% CI 3.1-78.8; P < 0.001). After adjusting for confounding factors, the multivariate analysis demonstrated a persistent association of AKN with HS (adjusted OR, 3.6; 95% CI 2.1-5.9; P < 0.001). This study demonstrated a significant association between AKN and HS in an Israeli population. The threshold for diagnosis of HS among patients with AKN must be lowered in patients presenting with concerning symptoms. Further observational studies in other patient populations will help confirm this relationship.

Refractory acne keloidalis nuchae treated with radiotherapy.

Acne keloidalis nuchae (AKN) is difficult to treat, and the clinical response is usually poor. Few reports have been published about scarring alopecia treated with radiotherapy (RT). We report a case of AKN that had been refractory to various other treatments but which responded to RT with excellent clinical and cosmetic results.

The efficacy of laser-assisted hair removal in the treatment of acne keloidalis nuchae; a pilot study.

BACKGROUND: Laser-assisted hair removal causes miniaturization of hair shafts which are the principal contributors to inflammation in acne keloidalis nuchae (AKN). OBJECTIVE: To assess the efficacy of hair reduction by long pulsed Nd-YAG laser as a therapeutic modality for AKN. METHODS: This interventional pilot trial included 16 patients with AKN who received 5 sessions of long pulsed Nd-YAG laser. Lesions were objectively and subjectively assessed at the third and fifth laser sessions, and 1 year after. Global response to treatment was rated using a quartile grading scale regarding the percentage improvement in the count of papules and the size of the plaques. Biopsies were taken before and 2 weeks after the fifth session to evaluate the pathological changes associated with improvement of the treated lesions. RESULTS: All patients showed a significant improvement. The percentage of improvement in the early caseswas significantly higher when compared to late cases.Two weeks after the fifth session, all biopsies showed a significant decrease in the inflammatory infiltrate except one case. Sclerosis was markedly decreased. Complete absence of hair follicles and adenexawas observed, apart from in 2 cases. CONCLUSION: Laser hair depilation can significantly improve this disfiguring chronic disorder. Starting treatment as early as possible achieves the best results and can stop the disease process if followed by maintenance sessions.

[How I explore ... primary cicatricial alopecias]. / Comment j'explore. Les alopécies cicatricielles primitives.

Primary cicatricial alopecias (PCA) result from the inflammatory destruction of the hair follicle, followed by its replacement by a fibrotic streamer. The involvement of multipotent stem cells of the hair follicle is possible through a transdifferentiation pathway. The diagnosis relies on clinico-pathologic correlations. PCA are classified as the neutrophilic, lymphocytic and mixed types. Each of these groups gather specific disorders including folliculitis decalvans, dissecting folliculitis of the scalp, erosive pustulosis of the scalp, keloidal acne of the nape, frontal fibrosing alopecia, lichen planopilaris and lupus erythematosus.

Folliculitis keloidalis nuchae is associated with the risk for bleeding from haircuts.

BACKGROUND: Folliculitis keloidalis nuchae (FKN), characterized by nucheal pimples and keloids, has a predilection for curly African hair. The disease is 10 times more common in males than females. The aim of this study was to investigate determinants of FKN in males. METHODS: Factors associated with the presence of FKN were investigated from two cross-sectional studies involving 1042 children and 874 adults, respectively. All participants had given informed consent. A clinical diagnosis of FKN was made only if nucheal keloidal papules (or plaques) were present. Multiple logistic regression was used to assess the relationship between FKN and specific characteristics in male participants. RESULTS: The odds ratio (OR) for FKN in males was higher in the adult than the child study [OR = 7.26, 95% confidence interval (CI) 3.13-16.88; P < 0.0001]. The OR in the group aged <25 years was similar to that in the group aged >50 years (OR = 2.44, 95% CI 0.75-7.89; P = 0.14) but significantly higher in those aged >25-50 years (OR = 5.75, 95% CI 2.67-12.64; P < 0.0001), which is inconsistent with inherent degenerative disease (in which the OR would be expected to increase or remain constant) and may correspond to the current popularity of closely shaven hairstyles. Most hair (86%) was cut close to the scalp with clippers, a process often accompanied by the exhibition of symptoms. For example, 47% of respondents reported transient haircut-related crusts or pimples (Yes vs. No, FKN OR = 3.44, 95% CI 1.43-8.301; P = 0.006), and 32% of adult males reported at least one episode of bleeding (Yes vs. Never, FKN OR = 3.45, 95% CI 1.23-9.68; P < 0.019). CONCLUSIONS: Prospective studies are needed to clarify the extent to which mechanical haircut-associated injuries cause or are the result of FKN. Haircut-associated bleeding raises concern about the potential transmission of blood-borne infections.

Acne keloidalis nuchae: another cutaneous symptom of metabolic syndrome, truncal obesity, and impending/overt diabetes mellitus?

Acne keloidalis nuchae (AKN) is an inflammatory disease related to the spectrum of keloidal scarring alopecias. No association with internal disease has been described so far. We describe a case series of four Indian patients who showed an association of AKN with acanthosis nigricans, a skin marker for the metabolic syndrome (in particular obesity). Well known risk factors for AKN such as curly hair or wearing of a helmet were not present in these patients. AKN shows some similarities to acne inversa. We propose that AKN may be considered a cutaneous marker for the metabolic syndrome but case-control studies will be necessary to validate this clinical observation. We hope that our findings will stimulate other dermatologists to search for such an association.

Comedones flexurales / Flexural Comedones

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Primary cicatricial alopecia: clinical features and management.

The primary cicatricial alopecias are an uncommon, complex group of disorders that result in permanent destruction of the hair follicle, usually involving scalp hair alone. Prompt diagnosis and treatment are needed to help thwart continued hair loss and the distress that often accompanies this hair loss. Nurses can facilitate the diagnostic and treatment process and, through educational and emotionally supportive measures, have a meaningful, positive impact on the patient's well being.

Quality of life of patients with keloid and hypertrophic scarring.

Keloid and hypertrophic scarring represent chronic disfiguring dermatoses with a high resistance to therapy. The aim of our study was to assess for the first time the quality of life of patients with hypertrophic scars and keloids, because they suffer from quality of life impairment as much as patients with other chronic skin diseases. An item-pool was created modifying and supplementing the items of the Questionnaire on Experience with Skin Complaints. This questionnaire was distributed to 100 outpatients with keloids and hypertrophic scars. A factor analysis was used to identify the underlying dimensions. Two scales (psychological and physical impairment) of the questionnaire with nine and five items, respectively, were established. Test-retest reliability of the questionnaire was excellent (corr > 0.9). Good validity was suggested by the correlation of physical impairment with pain (P < or = 0.001), pruritus (P < 0.001), and the amount of restriction of mobility (P < 0.001). The psychological scale was associated with pain and restriction of mobility, although the correlations were lower. This study demonstrates for the first time an impairment of quality of life in a large group of patients with keloid and hypertrophic scarring.

Mandibulofacial dysostosis (Treacher Collins syndrome): a case report.

Mandibulofacial dysostosis, also known as Treacher Collins syndrome, is a rare congenital anomaly that must be identified in infancy to prevent irrevocable developmental impairment. Information is sparse in the current medical literature concerning this rare syndrome. This article reports a case of Treacher Collins syndrome with the presence of a scarring alopecia and acne keloidalis nuchae, which are possibly coincidental symptoms, but have not been previously described clinically in this malady.