Cicatricial Alopecia of the Scalp as a Manifestation of IgG4-Related Disease Mimicking Acne Keloidalis Nuchae

January 2026 in “ Journal of Cutaneous Immunology and Allergy ”

Ayame Suwayama, Tomoko Kaminaga, Shujiro Hayashi, Shown Tokoro, Ken Igawa

cicatricial alopecia IgG4-related disease acne keloidalis nuchae alopecic plaque dermal fibrosis IgG4-positive plasma cells perifollicular inflammation serum IgG4 levels intralesional triamcinolone alopecia IgG4 immunostaining scarring conditions scarring alopecia steroid injection

TLDR IgG4-related disease can cause scalp hair loss that looks like acne keloidalis nuchae.

This case study discusses a 23-year-old Japanese man with scalp IgG4-related disease (IgG4-RD) that resembled acne keloidalis nuchae (AKN). The patient had a non-painful alopecic plaque on the occipital scalp, with dense dermal fibrosis and numerous IgG4-positive plasma cells, but lacked the perifollicular inflammation typical of AKN. Elevated serum IgG4 levels confirmed IgG4-RD. Treatment with intralesional triamcinolone led to mild improvement, though alopecia remained. The study emphasizes the need to consider IgG4-RD in atypical cicatricial alopecia diagnoses and the role of IgG4 immunostaining in differentiating it from other scarring conditions.

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Research cited in this study

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research Acne Keloidalis Nuchae: Prevalence, Impact, and Management Challenges

59 citations , December 2016 in “Clinical, Cosmetic and Investigational Dermatology”

Acne keloidalis nuchae is a tough-to-treat condition that greatly affects quality of life, especially in men of African descent.

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