Unveiling a Shared Precursor Condition for Acne Keloidalis Nuchae and Primary Cicatricial Alopecias

    Sanusi Umar, Donna Ton, Marissa J. Carter, Paul Shitabata
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    TLDR A condition with certain scalp changes may come before acne keloidalis nuchae and other similar hair loss disorders.
    The retrospective study analyzed 41 men diagnosed with Acne keloidalis nuchae (AKN), a type of primary cicatricial alopecia. It found that a subclinical disease characterized by perifollicular infundibulo-isthmic lymphocytic infiltrates lamellar fibrosis (PIILIF), and sebaceous gland destruction may precede AKN lesions. All patients' normal-appearing-scalp zones showed PIILIF features, with 96% showing absence of Vellus or miniaturized hair. The study suggests that PIILIF may be a precursor to AKN and possibly other Primary Cicatricial Alopecias (PCAs). It also found a significant reduction in anagen: telogen-catagen ratios and a decrease in hair count between non-alopecic scalp and AKN. The study was limited by its retrospective nature and the fact it was performed in an AKN specialty clinic. Further studies are needed to confirm the association between PIILIF and other PCAs.
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