Acne Keloidalis: A Review

Abstract

Acne keloidalis is a chronic scarring folliculitis located on the posterior neck of young black men. It is manifest clinically by follicular papules that coalesce into firm plaques and nodules. Examination of early lesions shows that inflammation begins at the deep infundibular and isthmic levels of the hair follicle and is accompanied by absence of sebaceous glands. The etiology of acne keloidalis is uncertain, but centers around anatomic, infectious, and autoimmune theories. Successful surgical therapy of advanced cases can be carried out using a number of methods as long as subfollicular destruction of the process is achieved.

The Surgical Management of Extensive Cases of Acne Keloidalis Nuchae

“…5,9 Close shaving of the neck in conjunction with the curved, coarse type of hair that is typically present in black patients has been proposed as an etiologic factor. 10,11 Constant rubbing of the neck and posterior region of the scalp by collars may also exacerbate AKN. 8,[11][12][13] The late lesions of AKN, with draining sinuses and large, keloidal masses, are often refractory to treatment, including therapy with topical and intralesional steroids, 5,8,12 topical and oral antibiotics, retinoids, 10,16 and irradiation.…”

“…8,[11][12][13] The late lesions of AKN, with draining sinuses and large, keloidal masses, are often refractory to treatment, including therapy with topical and intralesional steroids, 5,8,12 topical and oral antibiotics, retinoids, 10,16 and irradiation. 5,6,10,14,17 Surgical approaches to late-stage AKN include epilation, 5,8,12,14 excision with second-intention healing, 10,13,16 excision with primary closure, 5,14,16,18 and excision with grafting. 5,12,14,16,17,19 The purpose of this study was to determine the efficacy of excision with primary closure in the treatment of 25 patients with extensive and refractory AKN.…”

“…Previous articles have reported that excision with secondintention healing is more effective than primary closure, because primary closure scars frequently stretch to a large area, often to the size of a scar produced by secondintention healing, and may restrict movement if the head has to be bent back during the suturing of the wound to accomplish closure. 10,13 These complications may occur if the surgeon excises a large AKN in 1 stage and subsequently attempts to close the resulting defect under excessive tension. Spread scars and restricted movement may be avoided if large keloids are excised in 2 stages, thus allowing the surgeon to close the resulting defect without undo tension.…”

“…Recurrences are more likely to occur if the surgeon fails to achieve subfollicular destruction during surgical excision. 10,13,16 Thus, the excision must extend to the deep subcutaneous tissue or muscular fascia, since hair follicles typically penetrate the subcutaneous fat.…”

Dermatologia na pele negra

“…O tratamento é igual ao da PFB. 1,38,88 A foliculite dissecante do couro cabeludo (folliculitis et perifolliculitis abscedens et suffodiens) é quase exclusiva de indivíduos negros, afetando homens jovens. Possível causa é a oclusão folicular e a reação granulomatosa à queratina.…”