Figure 5 shows typical acne keloidalis nuchae . Women are rarely affected unless they shave their hair at the nape of the neck. This condition typically presents in young males with Fitzpatrick skin phenotypes V and VI (i.e. Acne keloidalis nuchaeĪlso referred to as folliculitis keloidalis, acne keloidalis nuchae is a chronic inflammatory condition in which painful pustules and keloid-like papules and plaques commonly occur at the nape of the neck . Additionally, if the patient is experiencing pain and discomfort, the patient should be referred to their GP for further assessment. Figure 4 shows the differences between scar types .įigure 4: Normotropic, hypertrophic and keloid scarsĪ scar showing signs of infection - such as swelling, bleeding, tenderness, warmth to the touch or presence of pus - should be referred urgently because a course of antibiotics is probably required. Hypertrophic scars appear immediately after trauma and show a tendency to gradually regress, whereas keloids can appear soon after injury or be delayed in appearance (developing months later) and are thought to very rarely spontaneously resolve . In contrast to keloids, hypertrophic scars are always preceded by trauma and confined to the margin of the wound . Hypertrophic scarsĪll trauma that involves the dermis will heal with a scar however, in some individuals, the scar is much larger and thicker than normal, resulting in a hypertrophic scar . Obtaining a detailed history can help to differentiate between different types of lesions and conditions with similar presentations (as outlined below). Scars on the face can be especially distressing and can therefore negatively affect a patient’s quality of life . restricting movement if growth is on joints) and their appearance can cause psychosocial distress. Keloids can cause pain and functional disability (i.e. Endocrine factors and local tissue components - especially wound tension or infection - are known to be involved in their formation .įigure 3: The shoulders and chest area are common areas for keloidal scars Excessive fibroblast proliferation and the deposition of matrix and collagen fibres causes the scar to expand from its original boundaries and continue to grow even after the wound has healed . In normal scarring, the collagen breaks down once the wound has healed, but this fails to happen during the formation of a keloid scar. ear piercings, burns, acne scarring and surgical wounds see Figure 1) .Ĭollagen plays an important part in wound healing, attracting cells (such as fibroblasts and keratinocytes) to the wound, encouraging debridement, angiogenesis and re-epithelialisation . Understand appropriate treatment and management options.Ī keloid scar, or keloid, is a dermal fibroproliferative growth caused by pathologic wound healing following injury to the skin (e.g.Identify patients who may require referral.Understand the presentation of and how to diagnose keloid scars.Journal of Pharmaceutical Health Services ResearchĪfter reading this article, you should be able to:.International Journal of Pharmacy Practice.Antimicrobial resistance and stewardship.
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