Keratosis Follicularis Spinulosa Decalvans And Acne Keloidalis Nuchae

A 27-year-old man presented with a 10-year history of scarring alopecia on the vertex of the scalp, follicular crusting, pustule formation, and a papular eruption on the posterior neck. He also had keratosis pilaris on the cheeks, eyebrows, and thighs. Histology revealed scarring with a mixed perifollicular inflammatory infiltrate and acute suppurative folliculitis. The diagnosis was keratosis follicularis spinulosa decalvans and concurrent acne keloidalis nuchae, a previously unreported association. The patient responded to oral isotretinoin 20 mg daily for 12 months.