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March 2008
By Kirkland Lau, DO, and Stephen M. Schleicher, MD
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CASE:
A 33-year-old African-American man requests treatment for severe scarring on his posterior scalp. The condition has gotten progressively worse over the last two years. The lesions usually begin as hard papules and are occasionally pruritic. At times, some are painful, cystic, and filled with pus. The patient’s medical history is unremarkable. Examination of his scalp reveals marked scarring and alopecia with discrete papules and cystic nodules at the periphery.
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The patient has scarring alopecia secondary to inflammation of scalp hair follicles. Clinical names for this condition include acne keloidalis nuchae and folliculitis decalvans. Cicatricial alopecia of this nature occurs almost exclusively in African-American men and is preceded by either a folliculitis or an abscess formation. The condition can be painful and result in significant cosmetic disfigurement. Afflicted individuals should avoid trauma (especially razor haircuts) and may benefit from long-term therapy with an antibiotic such as doxycycline. New lesions, as well as existing keloids and cysts, often respond to intralesional steroid injections. Surgical excision of affected areas may be indicated in refractory cases.
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Dr. Lau is an associate with a division of DermDx Centers for Dermatology in Sinking Spring, Pennsylvania. Dr. Schleicher is director of DermDx Centers and a clinical instructor of dermatology at the Philadelphia College of Osteopathic Medicine, at Kings College in Wilkes-Barre, Pennsylvania, and at Arcadia University in Glenside, Pennsylvania. He is also a member of the EMERGENCY MEDICINE editorial board.
Emerg Med 40(3):47-48, 2008
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