Acne keloidalis is most commonly seen in postpubertal males of African ancestry. The condition can resemble a scar or keloid, but is not considered a bone fide keloid.
In early disease, the patient usually complains of "pimples" affecting the nape of the neck, which can be pruritic and painful. Scattered pinpoint, soft to firm, brown or red papules or pustules with or without crusting are seen initially. The extent varies. In some individuals, large nodules and/or keloid-like plaques develop. Sinus tracts can occur within these larger lesions.
Treatment depends on the stage and extent of the disease. Early, mild papular or pustular disease can be managed with high-potency topical corticosteroids alone or combined with a topical antibiotic such as clindamycin. Larger, firm papules often require intralesional injection with triamcinolone acetonide. In patients with extensive cosmetically bothersome or symptomatic plaque disease, surgical excision is the only treatment option that is effective. The excision may be done in stages, depending on the size of the plaque, and tightness of the scalp if primary closure is done. Healing by secondary intention is another option.
Dermatology Nursing. 2007;19(2):137-143. © 2007 Jannetti Publications, Inc.