Perceived aetiological factors of folliculitis keloidalis nuchae (acne keloidalis) and treatment options among Nigerian men.

Abstract

Folliculitis keloidalis nuchae (FKN) also known as acne keloidalis is the commonest form of scarring alopecia occurring in African males. It occurs mostly in individuals of African descent. Its prevalence ranges from 1·6% to 16·1%. FKN is multifactorial in origin: androgens, inflammation, trauma, ingrowing hairs and secondary infection have all been implicated in its aetiology. The reason for its occurrence in the occipital region is unclear although elevated androgens in the scalp have been suggested. The occurrence of huge keloidal-like scars in the affected area has earned the name 'Bumps' in this environment. To look at the community's perception of the aetiological factors for bumps and perceived management options available in our environment. A community study was carried out among 1003 men residing in an urban community in Mokola, Ibadan, Oyo State, Nigeria. Data on sociodemographic characteristics, knowledge about aetiology, and prevalence of shaving bumps was obtained using a semi-structured questionnaire administered by trained interviewers. The chi-squared test was used to test the associations between presence of FKN and variables. The mean age of the respondents was 31·6 (SD=8) years. When asked about the cause of shaving bumps, 420 (41·9%) felt it was due to infection from barber's instruments, followed by heredity (110, 11%), poor shaving technique (81, 8·1%), cuts from shaving (52, 5·2%) and inadequate after shaving care (39, 3·9%). The prevalence of shaving bumps was 2·7%. The most commonly reported symptom among those with shaving bumps was itching (71·1%). Other symptoms include pain (9·6%) and bleeding (1·2%). Most of the patients (70·8%) who had ever had shaving bumps practised self-medication. Medications applied included oral and topical antibiotics (20·3%), Neo-medrol (10·9%), engine oil (9·4%) and traditional leaves (9·4%). About 50% of the responders believed FKN was an infective disorder. Although bleeding occurred while having a haircut, some individuals did not have their own personal shaving kits. Antibiotics, topical steroids, herbs and caustic substances were used for treatment. There is an urgent need to stimulate safer hair shaving practices and discourage the wrong treatment of FKN.