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PATIENT STORY

A young African-American man comes to the office because he has been bothered by the uncomfortable bumps on the back of his neck and lower scalp (Figure 120-1). He likes to wear his hair short but notices that every times he shaves his scalp, the bumps on his scalp get irritated. He is diagnosed with acne keloidalis nuchae. It was suggested that he minimize shaving the scalp and let the hair grow out a bit longer. Additional treatment consisted of 0.025% tretinoin cream and 0.1% triamcinolone cream once to twice daily to the involved area.

FIGURE 120-1

Acne keloidalis nuchae in a young African-American man. He likes to wear his hair short but notices that every times he shaves his scalp, the bumps on his scalp get irritated. (Reproduced with permission from Richard P. Usatine, MD.)

INTRODUCTION

Pseudofolliculitis is a common skin condition affecting the hair-bearing areas of the body that are shaved (Figures 120-2, 120-3, 120-4). Potential complications include postinflammatory hyperpigmentation, bacterial superinfection, and keloid formation. Acne keloidalis is a chronic disorder involving inflammation and scarring of hair follicles with development of keloid-like papules and plaques with scarring alopecia.

FIGURE 120-2

Pseudofolliculitis barbae along the jawline and neck in a young man. (Reproduced with permission from Richard P. Usatine, MD.)

FIGURE 120-3

Pseudofolliculitis barbae in a Latin American man. Note the active pustules on the neck. (Reproduced with permission from Richard P. Usatine, MD.)

FIGURE 120-4

Pseudofolliculitis barbae on the face of a 28-year-old African man who works providing aid to Darfur refugees. The painful nodules become worse every time he shaves. (Reproduced with permission from Richard P. Usatine, MD.)

SYNONYMS

  • Pseudofolliculitis—Razor bumps, shave bumps, ingrown hairs.

  • Acne keloidalis nuchae—Folliculitis keloidalis, sycosis framboesiformis, dermatitis papillaris capillitii.

EPIDEMIOLOGY

  • Pseudofolliculitis is most common in black men, with 45% to 83% of black men and 3% of white men who shave their facial hair developing pseudofolliculitis barbae.1,2 In the beard area it is called pseudofolliculitis barbae, and when it occurs after pubic hair is shaved, it is referred to as pseudofolliculitis pubis. It may also occur in any hair-bearing area.2

  • Acne keloidalis nuchae occurs most often in black men but can be seen in all ethnicities (Figures 120-1, 120-5, and 120-6). The lesions are often painful and cosmetically disfiguring.

  • Both conditions are seen in women, but far less ...

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