Acne keloidalis nuchae, which is also known as folliculitis keloidalis, primarily affects men of African descent and those with tightly curled hair. The condition develops when hairs on the back of the head or neck fail to emerge from follicles and the follicles become clogged with oil and bacteria. Acne keloidalis can prove extremely resistant to pharmaceutical treatments, so patients may require surgery and radiation therapy to clear away the lesions and nodules caused by acne keloidalis.
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Infections by Propionibacterium acnes play a role in a majority of acne out breaks. Antibiotics that have proven particularly effective against P. acnes include tetracycline, doxycycline (e.g. Vibramycin from Pfizer), clindamycin (e.g. Cleocin from Pfizer), erythromycin (e.g. E-Mycin from Abbott) and rifampicin. (e.g. Rifadin from sanofi aventis). A fact sheet on severe acne treatments from the American Academy of Dermatology notes that different strains of P. acnes often have or develop resistance to particular antibiotics. This means patients with acne keloidalis may need to try two or more antibiotics before finding one that works to treat their condition.
The three available isotretinoin products--Amnesteem from Genpharm, Claravis from Teva and Sotret from Ranbaxy--effectively treat many forms of severe acne. However, the synthetic form of vitamin A also has the potential for causing severe mental and physical side effects. Patients can only take isotretinoin if they sign up for and abide by the rules of a medication risk-reduction program called iPledge. The programs requires patients to use multiple forms of birth control, and women taking isotretinoin must have monthly pregnancy tests. These precautions are necessary because isotretinoin can cause severe defects in developing foetuses. All patients must also be aware of and monitored for suicidal thoughts and actions while taking isotretinoin.
Creams and ointments containing the corticosteroids betamethasone, clobetasol (e.g. Olux from Connetics), hydrocortisone, methylprednisolone (e.g. Medrol Acetate from Pfizer), mometasone (e.g. Elocon from Shering-Plough) or triamcinolone (e.g. Kenalog from Apothecon) reduce the inflammation and redness associated with acne keloidalis. Topical steroids can reduce the unsightliness of acne keloidalis lesions and nodules and relieve any discomfort patients are experiencing.
Injecting a low-dose of a corticosteroid can prevent a large acne keloidalis lesion from rupturing and leaving a scar. Steroid injections can also dissolve lesions for some patients.
When acne keloidalis does not respond to antibiotics, isotretinoin or steroids, patients have two surgical options. The first involves cutting open lesions and nodules with a scalpel and draining the growth. The American Academy of Dermatology cautions that this "drainage and extraction," or "acne surgery" as it is also called, should not be performed by patients. Dermatologists are trained in the proper technique and perform acne surgery under sterile conditions." The other surgical option involves using lasers to vaporise the layers of skin affected by acne keloidalis. Both kinds of surgery can leave large wounds on patients head and neck that can take months to heal completely.
Radiation treatments often follow either traditional surgery or laser surgery for acne keloidalis. This prevents reinfection of the surgical wounds with P. acnes or other bacteria.
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