An Overlap of Secondary Cutis Verticis Gyrata, Folliculitis Decalvans, Folliculitis Keloidalis Nuchae and the Use of Dreadlocks: The Role of Inflammation due to Traction

Abstract

We report a 29-year-old black male with cutis verticis gyrata, folliculitis decalvans and folliculitis keloidalis nuchae confirmed by biopsy. He had been using dreadlocks for 5 years before the appearance of the lesions. An activation of the different fibroblast growth factor members may explain the development of hyperproliferation of collagen, fibrosis and keloid lesions. We suggest a hypothesis of a common pathogenesis for the three conditions in a genetically predisposed patient. Inflammation and traction caused by the dreadlocks can act as a possible trigger factor.

Acne Keloidalis Nuchae is Associated with Cutis Verticis Gyrata

“…This association is probably due to a common causal denominator. Both conditions are histologically associated with dermal collagen thickening and fibroblast hyperactivity, 4 and can be induced by trauma or inflammation (shaving or tight weaving). 3–5 Furthermore, both conditions predominantly affect men, 5 , 8 , 9 while CVG is a hyperandrogenic condition, 10 AKN typically affects post-pubertal men and spares older men past their testosterone prime.…”

“…Vemurafenib can directly upregulate fibroblast activity by inducing paradoxical mitogen-activated protein (MAP) kinase signaling in primary human skin fibroblasts and inducing the production of TGF-β in melanoma cells. 14 Both processes can cause dermal collagen thickening, 4 , 15 which is found in both CVG and AKN. Notably, both patients described in the study 13 exhibited scalp-wide lesions described by the authors as erythematous hypertrophic plaques.…”

“…Acne keloidalis nuchae (AKN) is a form of primary cicatricial alopecia, typically confined to the occipital area and in men of color. The chief precipitating factors are microtraumas in predisposed individuals that accompany hair regrowth following head shaving, 5 posterior hairline carving, traction injuries from hair weaving, 4 , 5 , and trauma. Chronic rubbing of the nuchal area by shirt collars, caps, helmets, and wooden combs is also a common initiating factor.…”

“…A review of the literature reveals only one case report of CVG in a patient who had AKN and folliculitis decalvans. 4 Because AKN is often first observed in the nuchal area where scalp folds typically occur and the precipitating event might be skin friction within these folds, 5 we decided to investigate the potential relationship between CVG (a condition of excessive scalp skin folds) and AKN.…”

Distinct presentations of scalp dissecting cellulitis manifesting with furrows and gyri

“…Secondary forms occur as a consequence of neoplastic or inflammatory processes that produce deformities in the structure of the scalp. [3][4][5][6] Whilst primary CVG presents with an anteroposterior distribution, secondary CVG depends on primary aetiology. [3][4][5][6] DC may be one of the causes of secondary CVG, in which the folds tend to be asymmetrical but softer to palpation compared to the stiff folds on the final fibrotic stage DC.…”