The burden of gout in acne keloidalis nuchae-Insights from a population-based study.

BACKGROUND: The risk of gout amid patients with acne keloidalis nuchae (AKN) has not been investigated in the past. OBJECTIVE: To assess the risk of developing gout among patients with AKN relative to control subjects. METHODS: A population-based retrospective study followed patients with AKN (n = 2677) and age-, sex-, and ethnicity-matched control subjects (n = 13 190). The incidence of new-onset gout was compared between the two groups. Hazard ratio (HR) for the risk of gout was obtained using a multivariate Cox regression model. RESULTS: The incidence rate of gout was 1.12 (95% CI, 0.68-1.76) and 0.48 (95% CI, 0.34-0.66) per 1000 person-years among patients with AKN and controls, respectively. The crude risk of developing gout was significantly higher in patients with AKN (HR, 2.27; 95% CI, 1.26-4.10; p = 0.007). After controlling for age, sex, and ethnicity, AKN emerged as an independent risk factor of gout (adjusted HR, 2.34; 95% CI, 1.29-4.22; p = 0.005). When adjusting for other confounders such as body mass index, diabetes mellitus, hypertension, and dyslipidemia, the risk of gout in AKN fell out of significance (adjusted HR, 1.39; 95% CI, 0.73-2.65; p = 0.311), CONCLUSION: Patients with AKN experience an increased risk of gout. The risk is not independent and is mainly mediated through the metabolic comorbidities typifying AKN. We recommend screening for gout in patients with suggestive complaints.

A Neglected Acne Scar Type: Papular Acne Scars and Their Correlations With Keloid Scars.

BACKGROUND: Acne scarring can be divided into 2 types: atrophic and hypertrophic scars. Papular acne scars are commonly encountered, skin-colored papules on the chin and back. OBJECTIVE: This study aimed to estimate the prevalence of each acne scar type and to investigate the clinical manifestations of papular acne scars. METHODS: This retrospective study included 416 patients with acne scars. Dermatologists classified the scars into 3 types (atrophic, papular, and keloid type) based on clinical photographs and analyzed the clinical and histologic features of papular acne scars. RESULTS: Among 416 patients with acne scars, 410 patients (98.56%) had atrophic scars, 53 patients (12.74%) had keloid scars, and 46 patients (11.06%) had papular acne scars. Twenty patients (4.81%) had both papular and keloid acne scars. Histologic analysis showed fibrotic tissue in both keloid and papular acne scars. Fibrosis of the papular scar was limited to the upper dermis. CONCLUSION: Papular acne scars were significantly more prevalent in patients with keloid scars than in those without keloid scars. These results provide a basis for understanding papular acne scars, which have been under-recognized. The association between papular and keloid acne scars can suggest the decision for scar treatment.

Acne keloidalis nuchae and thyroid diseases: a population-based cohort study.

BACKGROUND: The association between acne keloidalis nuchae (AKN) and thyroid diseases is yet to be investigated. OBJECTIVE: To evaluate the risk of developing hypothyroidism and hyperthyroidism among patients with AKN and to characterize the patients who have AKN and thyroid comorbidities. METHODS: A population-based cohort study was conducted comparing AKN patients (n = 2,677) with age-, gender-, and ethnicity-matched control subjects (n = 13,190) with regard to incident cases of hypothyroidism and hyperthyroidism. Adjusted hazard ratios (HRs) were estimated by Cox regression analysis. RESULTS: The incidence rates of hypothyroidism among patients with AKN and controls were estimated at 2.15 (95% CI, 1.49-2.99) and 0.82 (95% CI, 0.66-1.00) cases/1000 person-years, respectively. The crude risk of developing incident hypothyroidism was 1.85-fold greater in patients with AKN (HR, 1.85; 95% CI, 1.24-2.78; P = 0.003). The elevated risk persisted following the adjustment for putative confounders (adjusted HR, 1.72; 95% CI, 1.03-2.89; P = 0.040). The risk of hyperthyroidism was comparable in patients with AKN and controls both in the crude (HR, 1.55; 95% CI, 0.57-4.22) and adjusted (adjusted HR, 1.92; 95% CI, 0.59-6.21) analyses. Patients with coexistent AKN and thyroid diseases were significantly older at the onset of AKN, had more prominent female preponderance, and had a higher burden of comorbidity. CONCLUSIONS: Patients with AKN are at an increased risk of hypothyroidism. Screening for hypothyroidism should be considered in AKN patients with a compatible clinical picture.

Acne keloidalis nuchae and hypertension in black subjects: a case-control study.

OBJECTIVE: The aim of this case-control study was to look for an association between hypertension and acne keloidalis nuchae (AKN) in black subjects. RESULTS: We recruited 303 consenting subjects comprising 101 patients with AKN and 202 controls, case-matched by age (± 5 years). The mean patients age was 34.9 ± 10.7 years versus 35.6 ± 11.2 years for controls. The average duration of AKN progression in cases prior to consultation was 1831 days (5 years). The most frequently observed AKN lesions were papules (73/101; 72.3%), fibrous scars (42/101; 41.6%) and folliculitis/pustules (41/101; 40.6%). In terms of quality of life, the mean score of dermatology life quality index was 8.3 ± 5.2 (extremes: 0 to 22). In multivariate analysis, having a BMI of 25 kg/m2 or more (OR = 4.91; p < 0.001) and having systolic hypertension (OR = 1.22; p = 0.010) were associated with AKN.

Acne Keloidalis Nuchae and the Metabolic Syndrome: A Population-Based Study.

BACKGROUND: The association between acne keloidalis nuchae (AKN) and the metabolic syndrome (MS) has been reported anecdotally. However, it is yet to be investigated in the setting of controlled studies, leaving this topic inconclusive in the current literature. OBJECTIVE: The aim was to estimate the association between AKN and the MS and its components, utilizing one of the largest cohorts of patients with AKN. METHODS: A retrospective, population-based, cross-sectional study was performed between 2005 and 2018. We utilized the database of Clalit Health Services, the largest public healthcare provider organization in Israel. The current study encompassed data collected from general community clinics, primary care, and referral centers, as well as from ambulatory and hospital care. RESULTS: A total of 2677 patients with AKN and 13,190 controls were included. The prevalence of the MS was greater in patients with AKN than in control subjects (16.1% vs. 6.6%, respectively; odds ratio [OR] 2.72; 95% confidence interval [CI] 2.40-3.08; P < 0.001). Obesity demonstrated the strongest association with AKN (OR 3.00; 95% CI 2.75-3.28), followed by type 2 diabetes mellitus (OR 2.47; 95% CI 2.20-2.77), hypertension (OR 1.82; 95% CI 1.63-2.05), and dyslipidemia (OR 1.60; 95% CI 1.46-1.75). Estimates were not altered significantly after controlling for putative confounding factors. CONCLUSIONS: A strong association was observed between AKN and the MS on the one hand, and with every one of its four components on the other. Physicians treating patients with AKN should be aware of this possible comorbidity. Patients with AKN should be carefully assessed for comorbid metabolic disorders.

Acne keloidalis nuchae in the armed forces.

Acne keloidalis nuchae (AKN) is a chronic inflammatory skin disease characterized by the development of keloidlike papules, pustules, and plaques on the occipital scalp and posterior neck following mechanical trauma and irritation. First-line therapy involves avoidance of aggravating factors including short and frequent haircuts. Medical treatments-from topical and intralesional steroids, oral antibiotics, and UV light to laser and surgical excision-have demonstrated varying degrees of efficacy. The active-duty military population faces unique challenges in the treatment of AKN because personal appearance and grooming standards restrict avoidance of the very factors that promote this disease process. In this population, early identification and treatment are critical to reducing overall patient morbidity and ensuring continued operational and medical readiness. This article reviews the clinical features, epidemiology, and treatments available in the management of AKN, with a special focus on the active-duty military population.

[Risk factors associated with acne keloidalis nuchae, in black subjects: A case-control study]. / Facteurs de risque associés aux folliculites fibrosantes de la nuque chez le sujet noir : étude cas-témoins.

OBJECTIVE: The aim of this case-control study was to identify risk factors associated with acne keloidalis nuchae (AKN), seen in a dermatology clinic in Lomé (Togo). PATIENTS AND METHODS: This was a case-control study conducted from January to December 2018. Patients were recruited at outpatients dermatological clinics and controls were recruited at outpatients dermatological clinics and then in other hospital departments. RESULTS: We recruited 303 consenting subjects, comprising 101 patients with AKN and 202 controls case-matched by age (±5 years). The mean patient age was 34.9±10.7 years vs. 35.6±11.2 years for controls. The most frequently observed AKN lesions were papules (73/101; 72.2%), fibrous scars (42/101; 41.5%) and folliculitis/pustules (41/101; 40.6%). In multivariate analysis, the following factors were associated with AKN: excess weight (adjusted odds ratio=4.8; 95% CI=[2.3-11.7]) or obesity (OR=9.2; 95% CI=[2.1-34.2]), bleeding during hairdressing either occasionally (aOR=13.9; 95% CI=[5.1-40.0]) or systematically (aOR=22.1; 95% CI=[6.2-40.7]), hairdressing procedures less than once per week (aOR=10.1; 95% CI=[3.2-50.8]), and extremely close cropping of hair (aOR=4.9; 95% CI=[2.8-15.5]). CONCLUSION: AKN is common in young adults. Excess weight or obesity, bleeding during hairdressing, and frequency and style of hairdressing are all associated factors. The results of this study stress the importance of limiting injury during hairdressing, and of refraining from shaving or cropping hair without a trimmer. Since management of AKN is extremely difficult, identification of associated risk factors allows suitable preventive approaches to be adopted.

Acne keloidalis nuchae: risk factors and associated disorders - a retrospective study.

BACKGROUND: Acne keloidalis nuchae (AKN) is a chronic scarring folliculitis which usually occurs in young adult males of African descent. Studies have suggested that AKN may be associated with other dermatologic conditions and even general medical disorders. The aim of this study was to identify cutaneous and extracutaneous associated disorders and to examine risk factors in our population for developing AKN. METHODS: The study was a retrospective, descriptive, and analytical study conducted at the Dermatology Outpatient department of the University Hospital of the West Indies. Data were obtained from the medical records of patients diagnosed over a 15-year period (2000-2014). RESULTS: There were 1031 new patients during the study period. Of these, 43 (4.2%) had AKN. The male to female ratio for AKN was approximately 7:1. Pseudofolliculitis barbae was associated with keloidal plaques on the scalp (OR = 6.22, P = 0.036). Also, when the duration of AKN was divided into two groups (0-5 years and greater than 5 years), there was an association between keloidal plaques and duration of greater than 5 years (OR = 7.5, P = 0.032). However, when the odds ratio was adjusted, only the duration of AKN remained significantly associated with keloidal plaques (OR = 7.08, P = 0.047). Chronic scalp folliculitis (P = 0.001) and the presence of any component disease of the metabolic syndrome (OR = 14, P = 0.008) and specifically hypertension (OR = 6.75, P = 0.036) were significantly associated with the extension of the lesions beyond the nape and occipital scalp. CONCLUSIONS: Pseudofolliculitis barbae, chronic scalp folliculitis, and aspects of the metabolic syndrome may be associated with acne keloidalis nuchae.

Follicular disorders of the face.

Follicular disorders are possibly a commonly seen, though rarely reported, group of disorders, which are localized around follicles and appendages and clinically present as small papules. Classically, clinicopathological follicular plugging is seen in the "true" follicular disorders, which are appropriately referred to as follicular keratosis. Another subtype is folliculitis (infectious or noninfectious) and the follicular mimickers that clinically resemble "true" follicular disorders without the follicular keratoses. Acne vulgaris has an amalgamation of all the above lesion types. Our review is aimed at describing all the follicular disorders and gives an algorithm for diagnosing the common follicular disorders.

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.

Hairdressing and the prevalence of scalp disease in African adults.

BACKGROUND: Anecdotal reports suggest that certain scalp disorders are common in Africans and may be associated with hairstyles. OBJECTIVES: This study of 874 African adults in Cape Town was performed to test this hypothesis. METHODS: A questionnaire was administered and scalp examinations performed, after ethics approval. RESULTS: Participants included 30.9% men and 69.1% women (median age 36.1 years, range 18-99). Most men had natural hair: 91.7% vs. 24.3% women. The majority of men had recent haircuts (< 4 weeks): 74.8% vs. 9.9% women. The overall prevalence of acne (folliculitis) keloidalis nuchae (AKN) was 3.5%: higher in men than women (10.5% vs. 0.3%). AKN prevalence was not associated with whether clippers or blades were used. However, it was associated with haircut symptoms. Haircut-associated symptoms, i.e. at least one episode of transient pimples (or crusts) and bleeding (however small) were reported in 37% and 18.9% of men, respectively. The latter may have implications for disease transmission. Most women (58.7%) had chemically treated hair (49.2% relaxed and 9.6% permed hair) vs. 2.3% men. The prevalences of traction alopecia (TA) and central centrifugal cicatricial alopecia (CCCA) were 22.6% and 1.9%: higher in women (31.7% vs. 2.2% and 2.7% vs. 0%, respectively). CCCA was highest in women > 50 years (6.7% vs. 1.2%). TA prevalence was highest if the usual hairstyle was extensions attached to relaxed hair (48%). CONCLUSION: We found associations between specific scalp diseases, hairstyles, gender, and age. These associations need further study, better to elucidate determinants and to improve disease prevention and treatment.

Prevalence of acne keloidalis nuchae in Nigerians.

BACKGROUND: The prevalence of acne keloidalis nuchae (AKN), a chronic inflammatory process of the hair follicles resulting in keloidal papules and plaques at the nape of the neck, is increasing in our environment. METHODS: A prospective hospital-based observational study was conducted at the adult medical dermatologic outpatient department of Irrua specialist teaching hospital, Edo State, Nigeria. All patients referred to the dermatology clinic with symptoms and signs of AKN were recruited. RESULTS: Thirty patients presented to the adult dermatologic unit with AKN over a period of 22 months, giving a gross incidence of 9.4% of dermatologic consultations. The common etiologic factor was secondary to trauma from an electric razor whilst having a haircut, followed by spread of keloid from the beard area. CONCLUSIONS: Minimization of trauma during hair cutting or shaving and personalization of haircare instruments may reduce the recently increased incidence of this condition in our environment.

Keloid acne of the neck: epidemiological studies over 10 years.

BACKGROUND Acne keloidalis nuchae is a chronic condition affecting young adult males of African origin. The frequency of the condition is low but its occurrence has a significant impact on the patient's quality of life. PATIENTS AND METHODS We performed a retrospective study on data collected over a period of 10 years in the Department of Dermatology and Venereology at the Centre National Hospitalier et Universitaire (CNHU) in Cotonou, Benin. We examined 90 files covering the period from 1993 to 2002 in terms of the epidemiologic, clinical and therapeutic features and course of the disease. RESULTS The frequency of acne keloidalis nuchae in patients attending the department for consultations over this period was 0.7%. All patients were male, and their mean age was 29 years. The mean period between disease onset and initial consultation in the department was 29 months. Of the patients diagnosed, 82.22% were seen at the stage when the keloid lesions were small. Lesion size did not appear to depend on the duration of the disease. The mean duration of follow up for the 34 patients reviewed was 22 weeks. In nine cases the lesions had spread and in five cases they had resolved. The treatment proposed depended on the type of lesion, but no effective therapeutic guidelines exist. CONCLUSIONS The study has demonstrated that, once the clinical stage of purely inflammatory lesions has passed, delay in consultation has a negligible effect on the course of the disease, which remains chronic and recurrent. A preventive approach using Information Education Communication (IEC) would be preferable.

Prevalence of acne keloidalis nuchae in football players.

BACKGROUND: Acne mechanica (AM) is common in football players. Severe cases of nuchal AM may precede acne keloidalis nuchae (AKN). Factors that may be associated with the progression of nuchal AM to AKN are unknown. The prevalence of AKN in football players has not been reported. OBJECTIVE: We investigated the frequency of nuchal AM and AKN within a susceptible population and attempted to identify factors that may be associated with AKN. METHODS: Four hundred fifty-three high school, collegiate, and professional football players were examined for the presence of nuchal AM or AKN. Those with positive findings completed a questionnaire regarding their disease. RESULTS: Nuchal AM was more prevalent in high school players (15.5%) than older players (1.2%). AKN was more frequent in players beyond the high school level and was found exclusively in blacks. AKN was not associated with a positive family history of AKN nor a positive personal or family history of keloid formation. CONCLUSION: AKN occurs almost exclusively in blacks. The level of football play may be associated with the development of AKN. Positive family history of AKN and positive family or personal history of keloids is not associated with AKN development.