(Sycosis frambesiformis; Acne keloid; Keloid acne)
Definition. – An inflammatory disease of the nuchae characterized by papules, pustules, vegetations and keloidal elevations.
Symptoms. – This rare disease begins with pin-head-sized, isolated papules or pustules at the border of the hair on the back of the neck, with a tendency to spread upward to the occiput. Subsequently, the lesions become aggregated, coalesce and form pea- to small cherry-sized, firm, projecting, pale or red, keloidal or papillomatous masses. On some areas, the hair remains twisted or matted, cannot be extracted with ease, or breaks off at the slightest touch, while others are entirely bald. If the growth at this stage is incised, the knife makes a creaking sound, and the exposed surface bleeds profusely. As the disease extends upward fungating, frambesiform vegetations appear, from between which an offensive exudate is discharged. Crusting is common, and multiple abscess formation undermines the growth at various points and to some extent destroys them. After a number of years a marked sclerotic degeneration, in the form of permanent alopecia, is noted while scattered about are tufts of normal hair.
Etiology and Pathology. – This disease is more common in adult males, especially in the negro race. Its cause is not known although most cases are secondary to furunculus, acne, sycosis or local trauma. It would seem to be due to some infection, possibly the staphylococci. There is some doubt as to the nature of the pathological process whether it begins about the follicles or as an inflammation in the cutis. The early formations consist of highly vascular papillary growths similar to granulation tissue but, later, sclerosis ensues with atrophy of the hair follicles.
Fig. 120. – Dermatitis papillaris capillitii in a young adult negro. The growth was removed by excision, followed by X-raying.
Diagnosis. – Except at its onset, when sycosis or acne on the back of the neck might bear a resemblance, it would seem almost impossible to mistake this disease.
Prognosis and Treatment. – A chronic, progressive course without any tendency to spontaneous cure and remarkable resistance to treatment, together with a permanent alopecia, represents the outlook. Local treatment is similar to that for sycosis, embracing strict antiseptic cleanliness, the extraction of hairs and evacuation of pus. Two cases of my own had the growth thoroughly excised, followed by X-raying and I believe this is the most promising treatment. Linear scarification electrolysis and electric cauterization have been recommended.