Keloid Acne of the Neck Aggravated by Pregnancy in a Woman

Abstract

Introduction: Keloid acne of the neck (KAN) is a dermatological pathology with very poorly explained etiopathogenesis and specific ethnic distributions; and almost always observed in black males. Case history: Miss N, 26 years old, came consulting for pruriginous scalp lesions, appearing intermittently over the last three years. These lesions first appeared during the first pregnancy, with an almost complete spontaneous regression after delivery 26 months before consultation. From the third month of the second (current) pregnancy, the patient noticed the aggravation of the lesions. The enabling factor in her past history was the habit she has of cutting her hair very low, and the current seven month pregnancy. On physical exam, she had android facial traits, hyperseborrhea, and polymorphous lesions associating follicular papules, nodules and a few pustules. These lesions were predominant on the back of the neck, the occiput, and the vertex. Serum testosterone level was normal, but that of dehydroepiandrosterone (DHEA) was twice the normal blood level. Discussion: The striking feature in this clinical case was the chronic scarring folliculitis, normally observed in males, during pregnancy with a relapse in the next pregnancy, associated to DHEA level twice the normal blood level. This was reported in a 30 year old Nigerian at two months of amenorrhoea and in whom the aggravation of lesions was evident from the onset of pregnancy. These cases suggest the pathophysiological hypothesis of pregnancy related hormonal impregnation.