| keloid scars are an idiopathic result of cuts, bruises, lacerations and often from surgical incisions. Medical therapy has been used with some results, but often surgical excision is necessary when the keloids are located in areas of exposed skin. Often skin grafting is necessary. The problem of keloid formation is more common in african americans and Asians in the united states. Because surgery of these lesions is sometimes considered cosmetic by HMOs and other insurance carriers, there exists a dispute between the medical profession and insurance carriers regarding the medical necessity of surgery. We have operated on many keloids in our practice; however, the case report we are presenting is a unusual and rare case of giant keloid formation requiring extensive surgery and x-ray therapy. ( info) |
| mandibulofacial dysostosis, also known as Treacher Collins syndrome, is a rare congenital anomaly that must be identified in infancy to prevent irrevocable developmental impairment. Information is sparse in the current medical literature concerning this rare syndrome. This article reports a case of Treacher Collins syndrome with the presence of a scarring alopecia and acne keloidalis nuchae, which are possibly coincidental symptoms, but have not been previously described clinically in this malady. ( info) |
3/17. Reversible sclerotic changes of lumbar spine and femur due to long-term oral isotretinoin therapy. We present a rare case of retinoid-induced sclerotic changes of lumbar spine and femur demonstrated by dual energy x-ray absorptiometrie (DEXA). The patient had flowing ossification along thoracic spine resembling diffuse idiopathic skeletal hyperostosis (DISH), but there was no ligament calcification in the lumbar spine or pelvis. After discontinuation of the treatment, gradual decline of bone mineral density at lumbar and femoral sites was detected with serial DEXA measurements. To the best of our knowledge, although various abnormalities of bone due to retinoids have been described before, reversible sclerotic changes have not been reported. ( info) |
4/17. Intralesional 5-fluorouracil in the treatment of keloid scars. Two patients with keloid scars are described. The first patient presented with extensive keloid scarring on both cheeks secondary to acne. The second patient developed a keloid scar on her chest following excision of a mole. Both patients' scars were diagnosed clinically and treated with fortnightly injections of a mixture of 5-fluorouracil and betamethasone acetate and betamethasone sodium phosphate. At each injection session up to 1.6 mL of 5-fluorouracil at a concentration of 500 mg/10 mL and 0.4 mL of betamethasone acetate and betamethasone sodium phosphate (as betamethasone acetate 3 mg in suspension and betamethasone sodium phosphate 3.9 mg in solution) were used. Multiple treatments were required to obtain resolution of the keloid scars. Improvement was maintained in both patients at 1 year post treatment. ( info) |
5/17. Acne keloidalis in females: case report and review of literature. Acne keloidalis, also known as folliculitis nuchae, is a form of chronic scarring folliculitis characterized by fibrotic papules and nodules of the nape of the neck and the occiput. It particularly affects men of African descent and is rarely ever seen in women. We here report the clinical findings of two Nigerian women who developed acne keloidalis. This report also reviews the pathogenesis of this disease. ( info) |
6/17. keratosis follicularis spinulosa decalvans and acne keloidalis nuchae. A 27-year-old man presented with a 10-year history of scarring alopecia on the vertex of the scalp associated with follicular crusting and pustule formation, and a papular eruption on the posterior neck. Additionally, there was keratosis pilaris on the cheeks, eyebrows and thighs. histology from the vertex showed scarring with a mixed perifollicular inflammatory infiltrate and foci of acute suppurative folliculitis. With clinical correlation, the diagnosis of keratosis follicularis spinulosa decalvans and concurrent acne keloidalis nuchae was made. The association of keratosis follicularis spinulosa decalvans with acne keloidalis nuchae has not previously been described. The patient responded to treatment with oral isotretinoin 20 mg (0.25 mg/kg) daily for 12 months. ( info) |
7/17. Efficacy of diode laser for treating acne keloidalis nuchae. Acne keloidalis nuchae is usually treated with oral antibiotics, local antiseptics or intralesional steroids but with limited success. I assessed the efficacy of diode laser for treating the inflammatory and keloidal papules of acne keloidalis nuchae in two cases. The lesions in both the cases showed about 90 to 95% clearance after 4 treatment sessions at one to one and half month intervals. No new lesions were observed during the follow up period of six months after the last laser treatment. Thus, after clearing bacterial infection, laser hair epilation can be used as the first line of therapy for treating papules of acne keloidalis nuchae. This is the first attempt at treating acne keloidalis nuchae with a diode laser. ( info) |
8/17. Acneiform eruption induced by lithium carbonate. A 26-year-old female developed a severe acneiform eruption on her face, chest and back soon after she started taking lithium carbonate for psychosis. Histopathological examination revealed it to be folliculitis, rather than true acne. The eruption continued for six months but was resolved three months after discontinuing the drug. It has not reappeared in the following 3 years. ( info) |
9/17. Acne keloidalis-like lesions on the scalp associated with antiepileptic drugs. A man developed acne keloidalis-like lesions in the scalp during treatment with diphenylhydantoin and carbamazepine for epilepsy. These drugs were suspected to play a role in the pathogenesis of this skin disease in an unusual location, based on clinical evidence and on the in vitro test, mast cell degranulation (MCD). ( info) |
| The earliest stages of acne keloidalis are not well characterized. In the present study, transverse sections of the early lesions revealed follicular units in several stages of inflammation. These follicles surrounded the central follicular units that gave rise to the clinically evident papule. Despite a spectrum of inflammatory changes, the most marked inflammation consistently occurred in the deep infundibular and isthmian levels of the hair follicles. Two follicles, presumably in the earliest stage, exhibited primarily an acute folliculitis and perifolliculitis, with destruction of the follicular wall and the release of hair. Central follicles showed predominantly acute neutrophilic or chronic lymphocytic inflammation at the upper isthmian levels and granulomatous inflammation at the deeper isthmian levels. Other follicles showed scar at the isthmian levels trapping hair fragments in the inferior portion of the follicle, with granulomatous inflammation and scarring. sebaceous glands were absent in all stages of folliculitis in seven of eight follicular units. ( info) |