Case Number : Case 2659 - 15 September 2020 Posted By: Uma Sundram

I seem to be taking the role of "first responder" here - always a hazardous occupation!

I see a mixture of acute, suppurative perifolliculitis and chronic perifollicular scarring.  I would check a Gram and PAS, but suspect this is acne keloidalis.

Multiple hair shafts within widened follicular infundibulae, with a lymphoplasmacytic and neutrophilic inflammation, in a scarring dermis----->> agree with Richard. 

Yes. Acne keloidalis nuchae.

I apologize for my late post. This is an example of how helpful a dermatopathologist can be when we are in the world of general and plastic surgeons. The patient had had numerous EIC excisions of the nape of the neck over many years before we ventured the dx of acne keloidalis. The patient was never referred to Derm and no one had previously suggested this dx. So, sometimes we are the Derm service, and can really be helpful.

It's very important to put the specific inflammatory pattern seen here in the correct context; in prior excisions it was attributed to rupture.