November 2002

Case submitted by Stephen M. Schleicher, MD, and Lawrence A. Schiffman, DO

		CASE: A 44-year-old African-American man who has just relocated to your area presents to your office as a new patient. In making the appointment, he related that in his former home town he was being seen by another dermatologist for a chronic "scalp condition." As you greet him, you note that his bald scalp appears normal, but once he turns his back to you, the diagnosis is classic and unmistakable.
What is your diagnosis?
		This patient has acne keloidalis nuchae, a condition that occurs most commonly in African-American men who cut their hair very short. The numerous kinks in African-American hair cause it to coil as it grows. As hair begins to emerge from the follicle, this coiling tendency allows the hair to re-enter the skin and cause inflammation. The ensuing folliculitis leads to keloid formation in those prone to it, as many African-Americans are. The occipital scalp is most often affected. The clinical presentation ranges from individual hyperpigmented, smooth papules and pustules to coalescing, fibrotic plaques and nodules. Treatment choices include intralesional triamcinolone, topical steroids, and oral antibiotics.

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Dr. Schleicher is director of the DermDx Centers for Dermatology of Northeastern Pennsylvania and a clinical instructor of dermatology at Graduate Hospital's City Line Campus in Philadelphia, Kings College in Wilkes-Barre, and Beaver College in Glenside, Pennsylvania. He is also a member of the Emergency Medicine editorial board. Dr. Schiffman is a fellow at the DermDx Centers for Dermatology.