Nuchal acne keloidalis associated with cyclosporin

Drug-Induced Acneiform Eruption

“…[60] Acne may be severe with a nodulocystic presentation [61,65,66] or may occur as acne keloidalis. [64] Treatment includes isotretinoin therapy, with anecdotal reports confirming its safety in transplant patients, [65][66][67] and possible cessation of cyclosporine with a switch to another immunosuppressive therapy. [61] Of note, coadministration of isotretinoin and cyclosporine should prompt careful monitoring of serum lipid levels.…”

“…Most of the cutaneous adverse effects of cyclosporine involve the pilosebaceous unit, including hypertrichosis, epidermal cysts, keratosis pilaris, folliculitis, and sebaceous hyperplasia. [60][61][62][63][64][65][66][67] Acne occurs in approximately 15% of patients. [60] Acne may be severe with a nodulocystic presentation [61,65,66] or may occur as acne keloidalis.…”

Update on primary cicatricial alopecias

“…Illustrative aspects of pathogenesis may be suggested by the reported occurrence of drug-induced acne keloidalis in white males who were treated with the anticonvulsants diphenylhydantoin and carbamazepine together (1 case) 357 and cyclosporine (4 cases). 358,359 Common to these drug regimens are cutaneous adverse effects that may simulate aspects of acne keloidalis that occur de novo. Histopathologic analysis of different stages of disease suggests that in predisposed persons, a progressive, locally destructive folliculitis incites reiterative cycles of acute and granulomatous inflammation with reparative fibrosis, eventuating in scar formation and transepithelial elimination of hair.…”

Diseases of cutaneous appendages

“…353,359 The lesions have caused secondary cutis verticis gyrata in affected persons. Postulated mechanisms include a seborrheic constitution, incurving hairs resulting from recurrent low-grade trauma (for example, by football helmets), 356,364 the use of antiepileptic drugs or cyclosporine, 365,366 and an increase in mast cell numbers in the occipital region. Surgery is sometimes required to manage the condition, when treatment with topical corticosteroids/antibiotics and oral antibiotics fails.…”