Folliculitis keloidalis in an urban market in Lagos, Nigeria: A community survey

Background: Folliculitis keloidalis (FK) also known as acne keloidalis nuchae is a follicular scalp disease found predominantly in males of African origin. Studies suggested that FK is associated with hair care practices and shaving. This study aimed to determine the prevalence of FK in a community in Lagos. Methods: This was a community-based, cross-sectional study at the Sandgrouse market in Lagos Island, Nigeria. Self-administered questionnaires were used to obtain demographic and clinical information. Diagnosis of FK was clinical and included follicular and keloidal papules, pustules, nodules, and tumors at the nape, sometimes spreading to other parts of the scalp, with intense itching. Results: A total of 100 males and 207 women were enlisted in the study and clinically evaluated for features of FK. None of the female participants presented with history and clinical features of FK. Seventy-five percent were between the age of 30 and 60 years. Fifteen male participants had a prior history of FK on the scalp and eight had previous treatment. Examination revealed the presence of FK in four respondents (4%): 3 had only on the scalp and one had on both the scalp and the beard area; and none had keloidal lesions. Conclusion: All respondents with FK presented at the early stage with keratotic/follicular papules. We posit that self-treatment with antibiotics and triple action creams (consisting of potent steroids, antifungal, and antibiotic) sold in the market and over the counter is responsible for the early and mild presentation.