Acne Keloidalis Nuchae Medication

  • Author: Philip R Letada, MD; Chief Editor: William D James, MD   more...
 
Updated: Aug 5, 2011
 

Medication Summary

The goals of pharmacotherapy are to reduce inflammation and eliminate infection, if present.

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Corticosteroids

Class Summary

These agents are used for their anti-inflammatory properties, but they must be used with caution because they have local and systemic side effects.

Topical corticosteroids may be used alone or in combination retinoic acid.

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Triamcinolone (Kenalog, Amcort)

 

For inflammatory reactions responsive to steroids; decreases inflammation by suppressing migration of PMN leukocytes and reversing capillary permeability.

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Prednisone (Deltasone, Meticorten, Orasone)

 

May decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. Used when patient has acute flare.

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Clobetasol propionate (Olux)

 

Available as a 0.05% foam (Olux).

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Fluocinonide (Lidex) or Mometasone furoate (Elocon)

 

Class 2 steroid (potent). Fluocinonide available as a 0.05% cream, ointment, and gel, and mometasone furoate available as 0.1% ointment.

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Retinoids

Class Summary

Although the exact mechanism of action is unknown, retinoids decrease the cohesiveness of abnormal hyperproliferative keratinocytes, modulate keratinocyte differentiation, and have anti-inflammatory properties.

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Isotretinoin (Accutane)

 

Oral agent that treats serious dermatologic conditions. Synthetic 13-cis isomer of the naturally occurring tretinoin (trans -retinoic acid). Both agents are structurally related to vitamin A.

Decreases sebaceous gland size and sebum production. May inhibit sebaceous gland differentiation and abnormal keratinization.

A US Food and Drug Administration–mandated registry is now in place for all individuals prescribing, dispensing, or taking isotretinoin. For more information on this registry, see iPLEDGE. This registry aims to further decrease the risk of pregnancy and other unwanted and potentially dangerous adverse effects during a course of isotretinoin therapy.

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Tretinoin topical (Retin-A)

 

Although exact mechanism of action is unknown, retinoids decrease cohesiveness of abnormal hyperproliferative keratinocytes, modulate keratinocyte differentiation, and have anti-inflammatory properties.

Available as 0.025%, 0.05%, and 0.1% creams. Also available as 0.01% and 0.025% gels.

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Antibiotics

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of this clinical setting.

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Erythromycin base (E-Mycin, Erythrocin)

 

Inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest. For treatment of staphylococcal and streptococcal infections. Age, weight, and severity of infection determine proper dosage in children. When twice-daily dosing is desired, half total daily dose may be taken q12h. Double the dose for more severe infections.

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Mupirocin (Bactroban)

 

Topical antibiotic; inhibits bacterial growth by inhibiting RNA and protein synthesis.

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Doxycycline (Vibramycin)

 

Broad-spectrum, synthetically derived bacteriostatic antibiotic in the tetracycline class. Almost completely absorbed, concentrates in bile, and is excreted in urine and feces as a biologically active metabolite in high concentrations.

Inhibits protein synthesis and, thus, bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria. May block dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

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Rifampin (Rifadin, Rimactane)

 

Inhibits RNA synthesis in bacteria by binding to beta-subunit of DNA-dependent RNA polymerase, which, in turn, blocks RNA transcription.

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Contributor Information and Disclosures
Author

Philip R Letada, MD  Resident Physician, Department of Dermatology, Naval Medical Center San Diego

Philip R Letada, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and Association of Military Dermatologists

Disclosure: Nothing to disclose.

Coauthor(s)

Elizabeth Kline Satter, MD, MPH  Chairman, Department of Dermatology, Naval Medical Center San Diego

Elizabeth Kline Satter, MD, MPH is a member of the following medical societies: Alpha Omega Alpha and American Medical Women's Association

Disclosure: Nothing to disclose.

Specialty Editor Board

James W Patterson, MD  Professor of Pathology and Dermatology, Director of Dermatopathology, University of Virginia Medical Center

James W Patterson, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Society of Dermatopathology, Royal Society of Medicine, Society for Investigative Dermatology, and United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

John G Albertini, MD  Consulting Staff, Dermatologic Surgery, The Skin Surgery Center; Program Director, ACGME Accredited Fellowship in Procedural Dermatology

John G Albertini, MD is a member of the following medical societies: American Academy of Dermatology and American College of Mohs Micrographic Surgery and Cutaneous Oncology

Disclosure: Nothing to disclose.

Glen H Crawford, MD  Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital

Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD  Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, A. Paul Kelly, MD, to the development and writing of this article.

References

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Numerous acne keloidalis papules and plaques in a white man with straight hair.
A large acne keloidalis plaque in a bandlike distribution at the posterior occiput in an African American man.
A large acne keloidalis plaque on the occipital region in an African American patient. This man also had perifolliculitis of the scalp and acne conglobata (the follicular occlusion triad).
Numerous papules that have coalesced into a large plaque, within which are tufts of hairs with several hair shafts exiting the same follicular orifice.
A dense plasma cell infiltrate surrounding a hair follicle.
Naked hair shafts embedded within a fibrotic dermis.
 
 
 
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