II. Pathophysiology

  1. Idiopathic
  2. May be secondary to localized forreign body reaction to hair (similar to Pseudofolliculitis Barbae)

III. Epidemiology

  1. Most common in black men
  2. Also occurs in hispanic, asian andwhite men
  3. Onset after Puberty and typically not after age 50 years

IV. Symptoms

  1. Variable pain and Pruritus

V. Signs

  1. Papules and Pustules on occiput and neck (each 2-4 mm)
  2. Papules and coalesce into Keloid-like mass in band-shape on the occipital scalp and posterior neck
  3. Alopecia occurs in involved region

VI. Complications

  1. Subcutaneous abscess with draining sinus
  2. Scarring Alopecia in involved area

VII. Management

  1. General Measures
    1. Avoid tight fitting shirts that rub the occipital area
    2. Avoid shaving or tightly clipping the occipital region
  2. Initial medical management
    1. High potency Topical Corticosteroids (e.g. Clobetasol, Betamethasone)
    2. Topical Antibiotics (e.g. Clindamycin)
  3. Additional medical management
    1. Oral antibiotics
    2. Retin A
    3. Imiquimod (Aldara)
    4. Accutane
    5. Surgical excision

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