Check Up : His scalp is a mess

April 25, 2017
Acne Keloidalis Nuchae

Trey is 32 years old and emails Check Up from Manchester. He suffers with pustules at the back of his scalp, which have even caused some keloid marks to occur.

He has obtained several treatments for the pustules but they always eventually recur. He asks Check Up what he can do to keep them away.

Trey should visit a consultant dermatologist. There are two conditions which come readily to mind which can look much the same.

One is acne vulgaris and the other is folliculitis keloidalis, or acne keloidalis.

Scalp acne (acne vulgaris) is formed just like the usual acne anywhere else on the body. There is excessive formation of oil in the sebaceous glands, which are located deep in the skin.


Glands blocked


These glands become blocked and later infected by bacteria. This results in the formation of white heads, black heads, pimples, pustules, cysts and even boils. Scalp acne can be caused by the following:

- Hormonal imbalance, especially during adolescence and female menstruation.

- Stress this is a common cause of painful acne.

- Heat and humidity.

- Environmental pollution.

- Some drugs, especially those containing hormones

- Thick hair products which block pores.

- Oily scalp.

- Friction or pressure to the scalp area from wearing helmets, hats and bandannas.

- Dirty sheets and pillow cases.

- It can be familial (inherited).

Treatment of scalp acne involves washing the hair frequently to eliminate excess oil. Salicylic acid in shampoos is acceptable. Oral medication includes topical and oral antibiotics.

Isotretinoin prescribed by a dermatologist is useful in persistent cases and treatment is long term. If left untreated for long , bald patches and scarring can occur.

Acne keloidalis is not really acne but is a type of folliculitis, an inflammation of the hair root follicle. It affects the nape of the neck and can persist for years.

It most often affects Afro-Caribbean men with black curly hair and is 20 times more common in males than females.

Itchy, round, small bumps occur within or close to the hairy area at the back of the neck. The bumps itch and can become infected with bacteria. Sometimes pustules also can be seen.

As time passes, the bumps become scars which can enlarge to form keloids. These scars are hairless and can eventually form a band along the hairline.

This condition is thought to begin very simply with a scalp injury while obtaining a close haircut, resulting in ingrown hair shafts which irritate the area.

Inflammation occurs which later results in scarring.

This condition is not easily treated, but the following methods do help:

- Avoid short razor-cut hair.

- Do not wear clothing of hats or helmets or shirt collars which rub on the neck back.

- Wash the area often.

- Apply ointments which can mix steroids with antibiotics and antifungal topical medications.

- Oral tetracycline, Clindamycin or other antibiotics are also used.

- Sometimes the area is injected with steroids directly into the swellings.

- Surgery to remove the keloid scarring.

- Laser treatment.

- Radiation treatment to the area.

Trey, Check Up hopes this is helpful. Make the lifestyle changes indicated above and see a dermatologist, please!

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