Category Archives: bumpinator

What is a Skin Tag or Dermatosis Papulosa Nigra (DPN)?

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Dermatosis Papulosa Nigra (DPN), often referred to as skin tags, is a common dermatological condition that presents as small, benign lesions on the skin. While generally harmless, these dark, raised papules can cause cosmetic concerns for many individuals, affecting their self-esteem. Understanding DPN’s symptoms, causes, diagnosis, and treatment options can empower those affected to effectively manage and address this condition, as knowledge is key to power.

What is Dermatosis Papulosa Nigra (DPN)?

Dermatosis Papulosa Nigra (DPN) is a common, benign skin condition characterized by small, dark, raised lesions on the skin. Although it primarily affects individuals with darker skin tones, it can occur in all skin types. These lesions, known as skin tags, are generally harmless but can be cosmetically concerning as more and more appear.

DPN can be easy to spot as as skin tags develop, such as on the skin of this patient – notice the raised, dark bumps present.

DPN as a Variation of Seborrheic Keratosis

Dermatosis Papulosa Nigra (DPN) is considered by some experts to be a variation of seborrheic keratosis. Histologically, DPN resembles seborrheic keratoses and shares a mutation in FGFR3 with seborrheic keratoses. However, it does not involve a mutation in PIK3CA. The condition may be cosmetically undesirable to some patients.

Symptoms of Dermatosis Papulosa Nigra (DPN)

Dermatosis Papulosa Nigra DPN presents with distinctive features that can help in its identification even from home:

Primary Symptoms

  • Small, Dark Papules: These are the hallmark of DPN, appearing as dark brown or black papules ranging from 1-5 mm in diameter. They are flexible to the touch and easy to measure from side to side.
  • Raised Lesions: The papules are typically raised and can have a smooth or rough surface.
  • Location: Commonly found on the face, particularly around the cheeks and eyes, but can also appear on the neck, chest, and back.

Secondary Symptoms

  • Cosmetic Concerns: The appearance of these lesions can be considered cosmetically unattractive.
  • Itching or Irritation: In some cases, the papules may become infected or irritated if rubbed or scratched repeatedly on purpose or by mistake, such as by clothing rubbing the papules during everyday movement.

What Causes Dermatosis Papulosa Nigra (DPN)?

The exact cause remains unclear, but several factors are believed to contribute to DPN’s development:

  1. Genetics:
    There is a strong genetic component to DPN, as it often runs in families. Individuals with a family history of DPN are more likely to develop the condition.
  2. Age:
    DPN is commonly found in middle-aged and older adults. However, DPNs can be seen in patients of any age.
  3. Skin Type:
    DPN predominantly affects individuals with darker skin tones, particularly those of African descent.
  4. Nevoid Developmental Defects: Dermatosis Papulosa Nigra is can be caused by a nevoid developmental defect of the pilosebaceous follicle.

Epidemiology and Demographics

A study in the International Journal of Dermatology states that DPN tends to occur in females with Fitzpatrick skin types IV to VI. The lesions commonly develop in the head and neck. They are often associated with a family history of DPN and significant sun exposure.

Like the other patient above, notice the dark, raised spots on her skin – the telltale sign of DPN, many skin tags.

How is DPN Diagnosed?

Diagnosis of DPN is typically straightforward and involves:

  1. Physical Examination:
    Dermatologists can diagnose DPN by visually examining the skin and identifying the characteristic papules to clear out other causes or skin disorders like cancers.
  2. Dermatoscopy:
    In some cases, dermatoscopy may examine the lesions more closely to differentiate them from other skin conditions.
  3. Biopsy:
    Rarely, a skin biopsy may be ordered to rule out other conditions.

Severity Classification

Though benign, dermatologists classify DPN lesions according to severity:

  • Fewer than ten papules: Mild
  • More than ten papules: Moderate
  • Greater than fifty papules: Severe

DPN vs. Regular Moles

DPN is unlike regular skin moles, which are more aligned with skin follicles. Moles occur when skin cells, known as melanocytes, clump up. Melanocytes produce melanin, which colors our skin. While normally evenly distributed, they will occasionally come together. A malignant growth tends to be an asymmetrical mole. DPN lesions, where one side is a different shape from the other, are pretty standard. DPN bumps both increase in size and grow in number over time.

How Do You Treat Dermatosis Papulosa Nigra (DPN)?

Treatment of DPN is generally not medically necessary but may be sought for cosmetic reasons.

Cosmetic Treatments

  • Cryotherapy: Freezing the papules with liquid nitrogen to remove them.
  • Electrosurgery: Using electrical currents to remove the papules.
  • Laser Therapy: Utilizing ablative laser technology to target and remove the lesions precisely.
  • Excision: Surgically cutting out the papules, usually performed by a dermatologist.

Topical Treatments

  • Retinoids: Topical retinoid creams can sometimes help reduce the appearance of DPN, although their effectiveness varies.

Self-Care

  • Avoid Irritation: Patients are advised to avoid scratching or rubbing the lesions to prevent irritation.
  • Regular Monitoring: Regular check-ups with a dermatologist to monitor the condition and manage any changes.

Frequently Asked Questions (FAQ)

  • Is Dermatosis Papulosa Nigra treatable? The condition benign and doesn’t call for treatment unless it affects a person’s lifestyle; several cosmetic procedures can effectively remove the lesions or reduce their appearance.
  • Is Dermatosis Papulosa Nigra hereditary? Yes, there is a significant genetic component, making it more common in individuals with a family history of DPN.
  • What causes Dermatosis Papulosa Nigra? The exact cause is unknown, but genetics, age, and skin type are contributing factors. Practicing sun safety and having a skincare routine are extraordinary preventative measures.
  • How can I treat Dermatosis Papulosa Nigra? Treatment options include cryotherapy, electrosurgery, laser therapy, and excision. Consult a dermatologist for the best approach. Complete a free consultation for your hair loss with board-certified dermatologist Dr. Sanusi Umar to see how the real-life Bumpinator can help you!
  • Can Dermatosis Papulosa Nigra be prevented? Since the exact cause of DPN is not fully understood and it often runs in families, prevention is not clearly defined outside of making smart, generally skin-safe decisions.

References

Furukawa, Fumina et al. “Treatment of dermatosis papulosa nigra using a carbon dioxide laser.” Journal of cosmetic dermatology vol. 19,10 (2020): 2572-2575. doi:10.1111/jocd.13309

Maghfour, Jalal, and Temitayo Ogunleye. “A Systematic Review on the Treatment of Dermatosis Papulosa Nigra.” Journal of drugs in dermatology : JDD vol. 20,4 (2021): 467-472. doi:10.36849/JDD.2021.5555

Nowfar-Rad, Mehran, MD; Elston, Dirk M., MD. “Dermatosis Papulosa Nigra.” Medscape, Jun 07, 2022.

Tran, Mimi, and Vincent Richer. “Elective Treatment of Dermatosis Papulosa Nigra: A Review of Treatment Modalities.” Skin therapy letter vol. 25,4 (2020): 1-5.

Xiao, Anny, et al. “Dermatosis Papulosa Nigra.” StatPearls, StatPearls Publishing, 7 August 2023.

What is PIILIF?

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What is PIILIF (Perifollicular Infundibulo-Isthmic Lymphocytoplasmic Infiltrates and Fibrosis)? It is a dermatological condition characterized by inflammation of hair follicles, hair loss, and scalp scarring. Recent research suggests that the condition affects scalp hair and other non-scalp hair follicles. In rare cases, PIILIF might involve the eyebrows, eyelashes, beards, and pubic regions.

Perifollicular Infundibulo-Isthmic Lymphocytoplasmic Infiltrates and Fibrosis is often ignored and mistaken for seborrheic dermatitis or dandruff, especially in cases where patients fail to manifest clinical symptoms.

What Causes PIILIF?

Researchers have not yet established the cause of Perifollicular Infundibulo-Isthmic Lymphocytoplasmic Infiltrates and Fibrosis. It likely signifies a low-level autoimmune attack of the hair. It is likely the precursor to currently recognized autoimmune scarring alopecias such as lichen planopilaris – LPP, frontal fibrosing alopecia – FFA, central centrifugal cicatricial alopecia – CCCA, acne keloidalis nuchae – AKN, Folliculitis decalvans – FD, dissecting cellulitis – DC. PIILIF  is largely influenced by several factors, such as; 

  • Genetics.
  • Hormonal. For instance, AKN and DC overwhelmingly affect men at the onset of puberty.
  • Environmental Triggers. Exposure to chemicals, allergens, pollutants, trauma, or scalp injuries. 
  • Scalp location
  • Infection/superantigen

Contexts Where Can PIILIF Be Found

Primary Condition

A doctor can diagnose PIILIF as a standalone condition with histopathological features and symptoms such as fibrosis, inflammation, and hair loss. However, it does not necessarily indicate the presence of other underlying conditions.

PIILIF Shared Precursor Condition for Acne Keloidalis Nuchae (AKN) and Primary Cicatricial Alopecias (PCAs)

Understanding the relationship between PIILIF and other Primary Cicatricial Alopecias (PCAs) can help diagnose and manage the conditions early to prevent progression.

A research study by Dr. Sanusi Umar, conducted on 41 male patients suffering from AKN, showed symptoms and signs of PIILIF. Moreover, the signs were also exhibited on the Normal-appearing scalp (NAS), away from the AKN lesions. The findings further highlighted the presence of scarring, inflammation, and scaling on some of the patients’ beards and other hairy body parts. This was evidence that PIILIF is a scalp condition and affects hair follicles in different body parts.

An illustration of PIILIF as a shared precursor condition to Primary Cicatricial Alopecias (PCAs).

Yet, other studies have established the occurrence of PIILIF in the normal-appearance scalp zones in the following classical scarring alopecia: LPP, CCCA, FFA, AKN, FD, and Dissecting cellulitis.

PIILIF(Perifollicular Infundibulo-Isthmic Lymphocytoplasmic Infiltrates and Fibrosis) Symptoms

  •         No symptoms
  •         +/- Hair loss  (Alopecia)
  •          +/- Itching, redness, and inflammation of the scalp
  •          +/- Scaliness/flaking

In addition, other symptoms may include early stages of Primary Cicatricial Alopecias (PCAs).

 

How Do You Diagnose PIILIF?

A clinical diagnosis is recommended for PIILIF, as the symptoms may overlap with those of other underlying conditions.

PIILIF diagnosis methods include:

  • Physical examination. A specialist will monitor visible symptoms on the scalp and other hairy body parts, such as the beard, eyebrows, and eyelashes.
  • Trichoscopy. This method evaluates skin lesions on the affected areas under a magnifying lens and lighting to confirm the presence of PIILIF.
  • Biopsy: A sample of hair or scalp skin is observed under a microscope to ascertain the PIILIF condition before prescribing further treatment.

How to Treat PIILIF(Perifollicular Infundibulo-Isthmic Lymphocytoplasmic Infiltrates and Fibrosis)

Although PILLIF cannot be cured, health practitioners have devised several treatment options to manage the condition and prevent its progression.

Another key point to note is that treating Perifollicular Infundibulo-Isthmic Lymphocytoplasmic Infiltrates and Fibrosis requires addressing other possible underlying conditions to counter the diseases in their early stages. This is because underlying conditions more often lead to severe PIILIF. 

Treatment options include:

  • Oral Medications:  Tetracyclines for their anti-inflammatory properties.
  • Topical Treatments. Consider Tacrolimus vs Pemicrolimin. 
  • Oral Supplements: EG Gashee oral.

PIILIF(Perifollicular Infundibulo-Isthmic Lymphocytoplasmic Infiltrates and Fibrosis) Frequently Asked Questions (FAQ)

Can PIILIF be cured?

There is no cure; however, an early diagnosis can prevent progression, and various treatment methods can manage the symptoms. 

Should I see a specialist for PIILIF?

Yes. Consult a certified board dermatologist for a proper diagnosis, as it might be a precursor for other diseases.

Finally, you can get a free consultation with Dr. Sanusi Umar through this link: https://dru.com/hair-free-consultation/ or by using the consultation button below. 

References  

Doche, Isabella, et al. “Acne Keloidalis Nuchae and Folliculitis Decalvans: Same Process Affecting the Follicle or Coexisting Diseases? A Retrospective Study.” International Journal of Dermatology, vol. 58, no. 10, 26 June 2019, https://pubmed.ncbi.nlm.nih.gov/31241169/

Umar, Sanusi, et al. A Retrospective Cohort Study and Clinical Classification System of Acne Keloidalis Nuchae. Vol. 14, no. 4, 1 Apr. 2021. Accessed 17 June 2024.

Umar, Sanusi, et al. “Unveiling a Shared Precursor Condition for Acne Keloidalis Nuchae and Primary Cicatricial Alopecias.” Clinical, Cosmetic and Investigational Dermatology, vol. Volume 16, 1 Aug. 2023, pp. 2315–2327, https://doi.org/10.2147/ccid.s422310. Accessed 17 June 2024.

Wang, Eddy H C, et al. “Primary Cicatricial Alopecias Are Characterized by Dysregulation of Shared Gene Expression Pathways.” PNAS Nexus, vol. 1, no. 3, 11 July 2022, https://doi.org/10.1093/pnasnexus/pgac111.

What is Dissecting Cellulitis?

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What is Dissecting Cellulitis? Dissecting Cellulitis (DC), also known as Hoffman disease, is a chronic (long-term) inflammatory scalp disorder that causes abscesses and keloids that lead to patchy hair loss and cicatricial (scarring) alopecia (destruction of hair follicles).

Dissecting cellulitis is incurable; however, somebody can manage symptoms to reduce pain and provide comfort.

DC is part of the follicular occlusion triad, where three diseases occur simultaneously. The other inflammatory diseases are acne conglobate (nodulocystic acne) and hidradenitis suppurativa (acne inversa).

The disease is most prominent in young adult black males but can, however, affect people of all races, ages, and sex.

What Causes Dissecting Cellulitis?

Specialists are working to determine the main cause of DC and establish why it affects some people and not others.

In this disorder, blocked hair follicles swell up and eventually rupture, causing inflammation underneath the skin.

Secondary Infection

The pus formed in the scalp following the follicle bursts becomes infected with bacteria over time, leading to further surface infections, hair loss, and scarring.

DC is often attributed as hereditary, but the disease rarely occurs in multiple family members. A small number of patients from the same family have experienced DC in the past, which leaves room for the assumption that genes play a role in the disease.  

Symptoms of Dissecting Cellulitis

DC, which starts as blocked hair follicles, worsens with time, with various signs and symptoms manifesting at the onset and later stages of the disease if not treated on time.

Early Symptoms

The most common onset symptoms include:

  • Swollen pimples on the scalp
  • Pus-filled painful lesions
  • Hair loss patches

Symptoms noticed in fewer cases:

  • Fever and swollen lymph nodes

Late Symptoms

  • Bleeding lesions
  • Permanent hair loss (fails to grow back after homecare treatments)
  • Wormlike skin fold between lesions
  • Scarring

If you exhibit the above symptoms, it is essential to seek immediate dermatology consultation, as they may indicate DC disease.

How is Dissecting Cellulitis Diagnosed?

Dermatologists usually diagnose DC through physical examinations of the scalp or infected areas. To further ascertain a DC diagnosis, they may swab pus (if the symptoms are at a later stage) or take scalp biopsies for histologic analysis.

Consult certified specialists and explain your symptoms in detail to avoid a misdiagnosis. 

What Does it Look Like?

A patient with a very severe case of dissecting cellulitis. He is currently receiving laser treatment under the care of Dr. Umar to manage symptoms.

What Treatments Are Available for Dissecting Cellulitis?

Once diagnosed, there are several recommended approaches to treating DC. As an incurable chronic condition, strategies have been put in place to manage active symptoms such as pain, hair loss, and lesions.

Medications 

There are three kinds of supplements used to manage DC:

  • Antibiotic oral supplements to fight infection. It is often recommended for long-term use to prevent relapse.
  • Steroid supplements are used in the short term to manage inflammation. They should be avoided in the long run to prevent severe side effects.
  • Oral retinoids help reduce follicle blockage and reduce acne. Retinoids cannot be purchased over the counter. Patients require a prescription from a certified dermatologist.

WARNING: Pregnant mothers are advised to refrain from retinoid use, which may cause extensive damage to the unborn child.

Topical Steroids

These are substances applied directly to the affected areas to reduce scalp inflammation. Examples include gels, lotions, ointments, and creams. These can be combined with topical antimicrobials and antiseptic scalp washes to reduce bacterial levels.

Surgery

Specialists may surgically drain large boils or painful abscesses to manage them by excising. Additionally, they can cut open the inflamed areas.

Surgical removal of the entire scalp skin is an extreme procedure and could be one of the most effective methods to manage DC. However, this procedure is for specific patients with severe cases. If the patient requests it, the doctor may follow other treatment methods for better results. 

Note: This exercise may leave scarring.

Other Treatments

  • Laser hair removal may lead to permanent hair loss.
  • Laser treatment to smoothen the scalp.
  • Radiation. 
  • Light treatment (photodynamic therapy). The procedure is slightly painful and might cause crusting. 
  • Steroid Injections are administered directly to affected areas. They are a painful procedure but have fewer side effects than steroid tablets.

Self-Care

  • Avoid smoking or tobacco use. Research findings have linked tobacco to cause DC.
  • Follow instructions and medications as directed.
  • Use medically approved products on your hair and scalp.
  • Maintain a normal, healthy diet.
  • Do regular check-ups with your specialist. 

A severe case of Dissecting Cellulitis (DC)

Dissecting Cellulitis (DC) and Acne Keloidalis Nuchae (AKN)

Dissecting Cellulitis can, in rare cases, coexist with other scalp and hair disorders.

Acne Keloidalis Nuchae, also known as AKN, is a skin disorder characterized by small or large bumps, often on the back of the head. Although common in males of African-American ethnicity, AKN can also affect people of other races.

AKN is often mistaken or misdiagnosed as razor bumps or keloidal conditions. It is far worse if left untreated. Use this link to ensure you get a diagnosis from a board-certified dermatologist like Dr. Sanusi Umar: https://dru.com/hair-free-consultation/. 

Some patients with severe scalp conditions may exhibit symptoms of both DC, AKN, and CVG (cutis verticis gyrata, a rare disorder common in males, characterized by deep skin folds on the scalp) due to overlapping risk factors. 

Additionally, multifaceted treatment is applied to ensure DC, AKN, and CVG are managed effectively. 

A patient with severe cutis verticis gyrata (CVG), acne keloidalis nuchae (AKN), and dissecting cellulitis (DC) conditions. He is currently receiving treatment under the care of Dr. Umar to manage symptoms. Notice the small and large bumps at the back of his head and the furrow-like appearance on the center of the scalp.

 

Dissecting Cellulitis Frequently Asked Questions (FAQ)

Is Dissecting Cellulitis Fatal?

Dissecting Cellulitis is not a deadly disease.

Is Dissecting Cellulitis Contagious?

No. Dissecting Cellulitis is not contagious and cannot be passed from one person to another.

Is Dissecting Cellulitis Curable?

No. It is incurable but can be managed.

How Can I Treat Dissecting Cellulitis?

You can complete a free consultation for your scalp condition with board-certified dermatologist Dr. Sanusi Umar using this link: https://dru.com/hair-free-consultation/ or the free consultation button below.

FREE CONSULTATION

References

Hintze, J. M., Howard, B. E., Donald, C. B., & Hayden, R. E. (2016). Surgical Management and Reconstruction of Hoffman’s Disease (Dissecting Cellulitis of the Scalp). Case Reports in Surgery, 2016, 1–4. https://doi.org/10.1155/2016/2123037

Tran, A. X., Lefante, J. J., & Murina, A. (2022). Risk factors for dissecting cellulitis of the scalp: A case-control study. Journal of the American Academy of Dermatology, 86(4), 941–943. https://doi.org/10.1016/j.jaad.2021.03.076

A New Beginning: Maria’s Liberation from 17 Years of Silent Suffering

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In medicine, few stories encapsulate the essence of perseverance, resilience, and the transformative power of skilled medical intervention as profoundly as Maria’s journey under my care. Folliculitis Decalvans (FD) rarely affects women; Maria is one of the few who was dealt the unlucky card. But Maria’s story doesn’t stop there.

Today, I am honored to share this remarkable testament to the unwavering human spirit and the impact modern medicine and empathy can have on a patient’s life.

The Beginning of Maria’s Struggle

Maria’s health issues began innocently enough, with what appeared to be dandruff and flaking. Believing it to be a manageable problem, she turned to medicated shampoos to find relief. However, as her condition worsened and her scalp began oozing pus, Maria faced a difficult choice – she had to stop breastfeeding her newborn son due to the prescription of antibiotics.

FD in women: Maria’s scalp lesion kept growing and started oozing puss.

The Misdiagnosis

When the lesions on her scalp grew larger, Maria was told she had lupus and began a rigorous treatment plan involving strong medications. Two years later, she received the shocking revelation that she had been misdiagnosed. 

The news engulfed Maria in frustration and a sense of hopelessness. The prolonged journey of ineffective treatments had taken a toll on her physical and emotional well-being, intensifying the challenges she faced in regaining control of her health. 

Meanwhile, the bump on her head continued to grow, and the medications intended to help only weakened her immune system, leaving her physically drained.

Years of Searching for Answers

Maria endured 20 specialists and 17 years of uncertainty and suffering as she sought a correct diagnosis for her condition. The toll on her physical and emotional well-being was immeasurable. It affected not only her but also her children, who witnessed their mother in constant pain and discomfort. They found themselves taking on caretaker roles at a young age.

The Turning Point: The Discovery and Intervention

Finally, Maria’s journey led her to my clinic, where a thorough examination identified the bump on her head as a Folliculitis Decalvans (FD) lesion. Considering that FD seldom impacts women, Maria’s situation appeared exceptional. Treating unique cases poses greater challenges due to the scarcity of reference points.

Recognizing the gravity of her situation, I extended an invitation for surgery in my private clinic – an offer she graciously accepted, marking a pivotal moment in her path to recovery.

Athena to the Rescue 

To permanently remove the FD, I utilized my bat excision method, a surgical approach designed for optimal wound closure with secondary intention healing (SIH). Given the relatively larger height of Maria’s plaque, I employed my patented Athena sutures, designed specifically to assist with SIH.

The Athena suture guard kit (named after my beloved late dog Athena) assists with secondary intention healing after the FD surgery.

A New Lease on Life

A year post-surgery, Maria reflects on her remarkable transformation. Free from the burden of pain and discomfort, as her FD has not returned since the surgery, Maria is now leading a tumor and pain-free life.

“God has plans for us, and he put Dr. U in my path like an angel. He has given me a new chance at life, a life without pain”, she says.

Maria’s FD removal results in 11 months post-surgery. *

Maria’s Gratitude

Maria’s gratitude knows no bounds, as she acknowledges the surgery’s positive impact on her and her children’s lives. The indescribable relief she feels is a testament to the dedication and commitment of the healthcare profession, and I am humbled to have played a role in her journey to recovery.

Maria, pictured with Dr. Umar. She’s grateful to live FD-free now.

Conclusion

Maria’s story is a beacon of hope for those grappling with undiagnosed conditions. It underscores the importance of perseverance and the potential for transformative healing when a patient and a dedicated healthcare professional come together. I am delighted to have been part of Maria’s triumph over adversity, and her journey serves as a reminder of the profound impact we, as healthcare providers, can have on the lives of those under our care.

FREE CONSULTATION

Frequently Asked Questions

How can I know if I have FD?

If you suspect Folliculitis Decalvans (FD), consult a dermatologist for diagnosis and treatment. Common signs include firm bumps, itching, inflammation, and spots filled with pus may develop. 

FD predominantly affects men of African and Hispanic descent but can also occur in white men and rarely in women, as you saw in this article. 

Seek professional help for an accurate diagnosis and follow recommended treatments, such as medications or laser therapy, to manage FD effectively. Avoid self-diagnosis and treatment, as proper medical guidance is essential.

I was treated for FD, but now it’s back. What can I do?

Most treatments commonly practiced for Folliculitis Decalvans (FD) only offer a temporary solution and may lead to constant visits to the doctor over a long period.

Luckily, Dr. Sanusi Umar came up with a permanent solution.

Using his specialized procedures and inventions he created such as his patented Athena Suture Kits, Dr.Umar AKA The Bumpinator has been able to successfully eliminate Folliculitis Decalvans (FD) in several happy and satisfied

References

Lupus (no date) Mayo Clinic. Available at: https://www.mayoclinic.org/diseases-conditions/lupus/symptoms-causes/syc-20365789 (Accessed: 04 December 2023).

Umar, S. (2019) Is Dandruff – Seborrheic Dermatitis, A Cause of Hair Loss and Poor Hair Transplant Outcomes?, dru.com. Available at: https://dru.com/is-dandruff-seborrheic-dermatitis-a-cause-of-hair-loss-and-poor-hair-transplant-outcomes/ (Accessed: 04 December 2023). 

Umar, S. et al. (2019) Innovative Surgical Approaches and selection criteria of large acne Keloidalis nuchae lesions, Plastic and reconstructive surgery. Global open. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6571336/ (Accessed: 04 December 2023). 

Further Reading 

https://bumpinator.com/bumpinator/what-is-folliculitis-decalvans/

Multiple Large AKN Bumps Removal: AKN Surgery Success Before & After Results

AKN Removal Results Los Angeles: Another Successful Case by The Bumpinator

Understanding the Factors that Predispose You to Keloids

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Keloids are raised scars that extend beyond the original wound, posing a mystery to researchers. Despite the unclear exact cause, various factors contribute to their development. This article delves into the elements that make someone prone to keloids, shedding light on the complex nature of this skin condition.

Genetics

Genetics significantly influences keloid development. Those with a family history or specific ethnic backgrounds, especially those with darker skin tones, are more susceptible to keloid formation.

Ethnic background and skin color are some of the factors making someone more or less prone to keloids.

Skin Color

Keloid likelihood is influenced by skin pigmentation. Darker skin is more prone to keloids, and the location of the wound matters. Areas with less fatty tissue, like the chest, shoulders, and earlobes, are more predisposed.

Medical Conditions

Certain medical conditions, such as acne and chickenpox, increase the risk of keloid development. Surgeries, particularly on the chest, shoulders, or earlobes, can also heighten the likelihood. Individuals with a keloid history should inform healthcare providers before undergoing surgery.

Vaccination Sites

Surprisingly, vaccination sites can become prime locations for keloids in individuals who have keloid predisposition. It’s crucial for those predisposed to discuss this risk with healthcare providers for alternative vaccination strategies.

Because of piercings, ears are one of the more commonly affected areas by keloids.

 

Age, Immune System, and Hormonal Balance

Research suggests that age, immune system function, and hormonal balance contribute to keloid development. Younger individuals are more prone, and hormonal fluctuations during puberty or pregnancy may increase susceptibility. A compromised immune system can affect scarring regulation, potentially leading to keloids.

 

Conclusion

While the exact cause of keloids remains elusive, understanding the contributing factors is crucial. Genetic predisposition, ethnicity, skin color, wound location, medical conditions, surgeries, vaccination sites, age, immune system function, and hormonal balance collectively shape the complex nature of keloid formation. 

Recognizing these factors empowers individuals and healthcare providers to take proactive measures in managing and mitigating keloid risks for better skin health.

Dr. Bumpinator, AKA Los Angeles board-certified dermatologist Dr. Sanusi Umar MD (Dr.U), advises individuals with keloid growth to seek guidance from a medical professional. 

FREE CONSULTATION

Further Reading

Should You Get a Tattoo if You Have Keloid-Prone Skin

Ear Keloid Treatment That You’ll Be Happy With….PERMANENTLY

Revealing a Common Precursor Condition in Acne Keloidalis Nuchae and Primary Cicatricial Alopecias

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Dr. Sanusi Umar, known as Dr. Bumpinator among fellow researchers and medical professionals, and his colleagues embarked on an investigative journey to explore the potential link between acne keloidalis nuchae (AKN) and primary cicatricial alopecias (PCAs). Their hypothesis centered on the existence of an underlying condition that precedes the development of AKN and other hair loss disorders. To unveil this connection, they utilized trichoscopy-guided biopsies and conducted comprehensive clinical assessments.

This noteworthy study found its home in the pages of the Clinical, Cosmetic and Investigational Dermatology Journal and holds the potential to transform the understanding and approach to treating various hair and scalp conditions. Dr. Bumpinator is the lead author of the paper titled “Unveiling a Shared Precursor Condition for Acne Keloidalis Nuchae and Primary Cicatricial Alopecias.”

The groundbreaking study was published in the Clinical, Cosmetic and Investigational Dermatology Journal. This patient has a diagnosis of AKN in the nape area and FD in the right vertex area.

Revealing the Concealed Precursor: PIILIF

Their research journey led to unmasking a hidden precursor they termed “perifollicular infundibulo-isthmic lymphocytoplasmic infiltrates and fibrosis,” or PIILIF. The team identified this subclinical disease in all 41 male patients with AKN, not only in the affected AKN zones but also in seemingly healthy scalp regions distant from the AKN lesions. Biopsy images vividly displayed PIILIF, with vertical and horizontal biopsies providing essential insights.

The significance of their findings lies in the potential link they established between PIILIF and various primary cicatricial alopecias. PCAs include challenging conditions such as dreaded AKN bumps and folliculitis decalvans (FD). This discovery bears crucial implications for the early diagnosis and management of these conditions, prompting a shift in focus beyond visible symptoms to explore hidden precursors as potential causative factors.

NAS biopsy showing PIILIF (A-vertical biopsy, B-horizontal biopsy).

The Implications in Treatment Strategies

Dr. Bumpinator’s research has a practical clinical focus. It aims to address real-world concerns rather than being confined to a scientific puzzle. The research team posits that PIILIF may play a substantial role in developing different hair and scalp disorders. Detecting its presence holds the promise of more efficient treatment methods and preventive measures. Intervening at the PIILIF stage could prove instrumental in slowing down the progression of AKN and other associated PCAs.

The Road Ahead

As the exploration of the intricate relationship between PIILIF and primary cicatricial alopecias continues, numerous questions remain unanswered. Dr. Bumpinator and his team are driven to unravel what triggers the transition from PIILIF to the more visible alopecia conditions, whether genetic factors predispose individuals to PIILIF, and how treatment approaches can be tailored effectively to target this hidden precursor.

In conclusion

Dr. Bumpinator’s research substantially contributes to comprehending hair and scalp disorders. It is another attempt at getting closer to the permanent termination of the back of head bumps.  Identifying the common precursor condition of AKN and PCAs paves the way for further research and treatment advancement. They hope this discovery will foster cooperation among researchers, dermatologists, and medical practitioners, sparking a reevaluation of the approach to these conditions. As they delve into the intricacies of scalp issues, they remain open to the possibilities beneath the surface, aiming to brighten the future of dermatology and hair health through their innovative discoveries and insights.

Should You Get a Tattoo if You Have Keloid-Prone Skin

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So, you have keloid-prone skin and want to get a tattoo. It can feel frustrating not knowing if it’s worth the gamble or if you should play it safe. Understanding what makes someone prone to keloids, assessing all the risks, and learning how to prevent and manage keloids may be helpful in coming to a decision. 

What Makes Someone Prone To Keloids? 

While the exact cause of keloids is not fully understood, several factors may contribute to their development, including genetics, ethnicity, skin color, and the location of the wound. Additionally, certain medical conditions, such as acne and chickenpox, and certain surgeries may also increase the likelihood of developing keloids. Vaccination sites are also prime locations for keloids if you have keloid-prone skin. Finally, evidence suggests that a person’s age, immune system, and hormonal balance also play a role.

Ear keloid bump and the healed ear post-surgery. *

 

Should You Get That Tattoo?

Keloids can occur with tattoos or piercings, but they are uncommon. Studies estimate that keloids develop in 5-10% of people who receive tattoos and up to 30% of people who get piercings. However, keloids are more likely to develop in people who have a family history of them or who have dark skin. If you are worried about keloids, talk to your dermatologist to assess the risks, and talk to the tattoo artist about the best ways to prevent them.

Tattooing Over A Keloid Scar

Tattooing over a keloid scar can be risky, as the scar tissue may not hold the ink well and may cause the tattoo to appear blurry or uneven. It’s best to consult a professional tattoo artist with experience working with keloid scars to determine if tattooing over the scar is safe and feasible. Additionally, it’s always a good idea to consult a dermatologist before investing in a tattoo over a keloid scar.

Your Tattoo Triggered a Keloid Growth. Now What?

One recommended treatment for keloids is steroid injections, which can help to reduce inflammation and promote healing. Other options include cryotherapy, laser therapy, and radiation therapy. It’s essential to consult a dermatologist to determine the best treatment for your particular situation,  especially because keloids tend to return after removal – often, more invasively. 

Surgical keloid removal is the most effective way, especially for bigger scar tissues. It is vital to have the procedure performed by a qualified and experienced physician to ensure the best possible outcome. Try to find a specialist with a track record of permanently removing keloids. 

Dr. U., AKA The Bumpinator

Regarding keloids, Dr. Bumpinator, AKA Dr. Umar, is one of the most qualified surgeons. As a pioneer in scar and skin bump removal, he has developed advanced surgical techniques to masterfully rid his patients of dreadful bumps. 

the terminator of unwanted skin bumps

The removal of the keloids is only part of the job. For many patients coming in, Dr. Bumpinator is not the first dermatologist they visit. Keloid scars are known for frequently returning post-removal. This is because keloid-prone skin overproduces collagen to repair itself post-trauma. A surgical incision is also registered as trauma, so if you’re prone to developing raised scars, it shouldn’t come as a surprise if you start seeing new growth at the surgery site. 

 

This is why seeing a doctor who deals with keloids is especially critical. Dr. Bumpinator strives for long-lasting results post-removal. Read about how this young man had a keloid for almost 20 years and had gotten it removed and treated five times before coming to Dr. Umar. Each time, his keloid would return bigger. Dr. Umar’s goal was to make the patient’s sixth time his last. 

FREE CONSULTATION

FAQ

I got a tattoo a month ago, and no keloids so far. Am I in the clear?

It’s hard to tell because keloids can take months to start developing after trauma. If you have keloid-prone skin, continue monitoring the area to catch it earlier if you develop a keloid. 

 

I have a keloid at the site of my piercing. Does this mean a tattoo will also cause a keloid?

Although there is no sure way of predicting whether a tattoo would trigger keloid growth, the fact that you already have a keloid indicates that your skin tends to it. A tattoo is a minor skin trauma than a piercing, especially if you’re not getting a big piece. There is a good chance you’re safe to get a tattoo, but theoretically, you’re at risk. 

 

References

  1. Keloid Scar. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/keloid-scar/symptoms-causes/syc-20520901#:~:text=Keloid%20growth%20might%20be%20triggered,aren’t%20contagious%20or%20cancerous. Published October 11, 2022. Accessed March 27, 2023.
  2. Keloid scars: Overview. American Academy of Dermatology. https://www.aad.org/public/diseases/a-z/keloids-overview#:~:text=Researchers%20have%20found%20that%20between,have%20a%20darker%20skin%20tone. Accessed March 27, 2023.
  3. Keloids. Pennmedicine.org. https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/keloids. Accessed March 27, 2023. 

 

Breaking the AKN Curse!

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This Hispanic male patient was suffering from a large AKN lesion at the nape of his head. The mass was 12cm in length and, being a stage 2 plaque, was taking up a significant part of his scalp. The patient was not happy with how unsightly the lesion looked. He also experienced itching and flaking because of it. 

 

A Family Curse – AKN Lesions

This patient had a family history of AKN. Both his father and brother had AKN lesions, so although his initial thought was it the bumps were a result of razor burn, he had a theory that it must’ve been genetic. He was right about that, of course. AKN is not caused by razor burn, although skin-close haircuts can trigger lesion formation. 

 

The young man had tried to eliminate or partially dissolve his AKN plaque with steroid injections but saw no improvement. That’s when he came to Dr. Bumpinator, AKA Dr. Umar, as his last resort.

The patient had a large AKN plaque at the nape of his head.*

 

AKN, begone!

If there’s one thing you can be sure of, it’s not AKN safe from Dr. Bumpinator – family history or not. When the patient came to him, Dr. Bumpinator first assessed the plaque to classify it. Based on its 5 cm height, the plaque fell under Class II categorization. As for its type, it’s a combination of keloidal and tumorous mass.

For this class and type of AKN, Dr. Bumpinator judged surgical removal as the best option. 

He performed the surgery in his clinic in Manhattan Beach without any complications. Dr. Bumpinator excised the AKN plaque using the bat excision technique he developed. Once the mass was removed, he brought the wound edges closer and held them together with the Athena suture guards.

 

Dr. Bumpinator used his patented Athena suture guards for this AKN removal procedure.

 

The Athena suture guards ensure optimal wound healing and mitigate unnecessary stress on the procedure site. It is also used to dictate the scar’s shape that eventually results.

 

A Fresh Start 

The patient could embark on a new, AKN-free chapter of his life through surgical removal. Despite his family history of AKN, he would be able never to have to worry about his AKN lesions again. He was delighted with the results and the way his wound healed. The scar looked subtle enough and was aesthetically acceptable. 

 

This young man had a family history of AKN and was able to get his lesion removed with Dr. Bumpinator’s help.*

 

The video below demonstrates the excellent results of the patient’s AKN removal surgery.

 

 

References

  1. Medicinenet.com. 2022. [online] Available at: <https://www.medicinenet.com/flaky_scalp/symptoms.htm> [Accessed 25 August 2022].
  2. Umar S, David CV, Castillo JR, Queller J, Sandhu S. Innovative Surgical Approaches and Selection Criteria of Large Acne Keloidalis Nuchae Lesions. Plast Reconstr Surg Glob Open. 2019;7(5):e2215. Published 2019 May 16. doi:10.1097/GOX.0000000000002215
  3. Umar S, Lee DJ, Lullo JJ. A Retrospective Cohort Study and Clinical Classification System of Acne Keloidalis Nuchae. J Clin Aesthet Dermatol. 2021;14(4):E61-E67.

 

Frequently Asked Questions

 

Is AKN hereditary?

Although the exact causes of AKN are unknown, you may be genetically predisposed to having AKN lesions. 

Is AKN a rare condition?

Unfortunately, AKN is relatively common in Black and Hispanic men. It is, however, rare in people of other ethnicities. 

 

Further Reading 

https://bumpinator.com/bumpinator/small-akn-bumps-removal-by-the-bumpinator-not-barbers-rash/

https://bumpinator.com/bumpinator/how-this-big-lucky-akn-bear-overcame-his-breaking-point-part-1/ 

 

A Man is Finally AKN-Free After 10 Years of Living with a Lesion 

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What is AKN: Acne Keloidalis Nuchae, often abbreviated as AKN, is a skin condition that manifests in the form of small or large painful bumps on the back of the head. In their initial state, the small bumps can be confused for razor burns. In reality, the condition is genetic, and buzz haircuts are just a trigger for it. 

This 36-year-old patient had a large lesion for 10 years and didn’t know what had caused it. He came to Dr. Umar, also known as Bumpinator, to get his AKN plaque surgically removed.

 

Dr. Bumpinator, AKA Dr. Umar, started off by evaluating the patient with his AKN classification system. He identified the patient’s lesion as a flat follicular plaque with Class III distribution.

He then used his bat excision method to surgically remove the AKN lesion in a fashion that ensured the most optimal wound closure with secondary intention healing (SIH). As the patient’s plaque was relatively larger in height, Dr. Bumpinator used his patent-pending Athena sutures to assist with the SIH.

 

Dr. Bumpinator used his Athena suture guard-assisted bat excision technique to remove the AKN lesion. *

 

Taking care of the AKN operation side is critical for the optimal healing and fading of the scar. Here, the wound has assumed the natural shape of the posterior hairline. Already discernible natural look as the wound continues to heal several weeks after removal by Dr. Sanusi Umar *

 

You can see the patient’s results, which are nothing short of life-changing.

The AKN patient had his flat follicular plaque surgically removed by Dr. Umar. *

The patient’s post-op scar is clean and healed without any complications. As seen in Before and After comparison photos above, his hair growth after surgery completely covered up the scar. 

 

Frequently Asked Questions

 

Can I use medication to treat my AKN?

You can use steroid medications to address the inflammatory aspect of your AKN. You can also try antibiotics if you notice a bacterial infection with your AKN. However, you are not likely to be able to get rid of the lesions with medications alone. If you have AKN and want to get rid of it for good, contact Dr. U (Bumpinator), who will assess your condition to come up with the most optimal treatment for you.

 

My AKN bumps keep growing. How big can I expect them to get?

Unfortunately, AKN is known to worsen over time, meaning that AKN bumps can grow in size ranging from their depth, width, the affected area, and more.

You can consult Dr. Umar, A.K.A., the Bumpinator, to determine how to permanently eliminate your AKN lesion using any of his techniques.

 

 

References

  1. Umar S, David CV, Castillo JR, Queller J, Sandhu S. Innovative Surgical Approaches and Selection Criteria of Large Acne Keloidalis Nuchae Lesions. Plast Reconstr Surg Glob Open. 2019;7(5):e2215. Published 2019 May 16. doi:10.1097/GOX.0000000000002215
  2. Umar S, Lee DJ, Lullo JJ. A Retrospective Cohort Study and Clinical Classification System of Acne Keloidalis Nuchae. J Clin Aesthet Dermatol. 2021;14(4):E61-E67.
  3. What Is Acne Keloidalis Nuchae?. WebMD. https://www.webmd.com/skin-problems-and-treatments/what-is-acne-keloidalis-nuchae. Published 2022. Accessed August 3, 2022.

 

 

Multiple AKN “Razor Bumps” And What to Do About Them

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Multiple AKN bumps on the back of the head: Acne Keloidalis Nuchae, or AKN bumps, often appear in multiples. Since the condition often follows episodes of close shaving with a razor, it is called barber’s rash and AKN razor bumps, Those tiny bumps may grow eventually, and some of them may merge to form a plaque or even a tumor-like mass. Most individuals suffering from AKN will still be left with more than one bump.

That was the case for this young man of Hispanic descent. He had many small bumps scattered all over the back of his head. However, his main concerns were the two prominent lesions in the nape area. One of those was particularly big, and the patient was experiencing lots of pain and discomfort. 

Dr. Bumpinator to the Rescue

Before coming to Dr. Umar, the patient had tried to get rid of those bumps through an unsuccessful surgery. After that attempt, he researched and learned about the Bumpinator (Dr. Umar). In 2019, he came to Dr. Umar’s Manhattan clinic for consultation, where he was told his AKN consisted of Class 2 plaques and tumorous mass, and consequently decided to get the masses removed by the doctor.

Figure 1 The AKN patient had two lesions and many small bumps, which he wanted to be removed by Dr. Umar. *

 

Dr. Umar used his unique technique to surgically remove the biggest plaque on the lower part of the patient’s head. One major problem AKN removal surgeries cause is wide and abnormally shaped scars that look out of place. Using surgical techniques he developed and tools that he invented, including the Athena Suture guards, Dr. U can control the wound healing process, ultimately resulting in the minimization of the scar and the bending of the scar to a closer shape to that of a posterior hairline. Dr. U recommended the patient wait for the removal of the smaller plaque until the incisions from the first surgery healed. He also recommended that the smaller scattered satellite lesions can be addressed by laser treatment.

 

Figure 2 Dr. Umar, AKA the Bumpinator, used the Athena sutures he invented to remove the AKN plaques successfully.*

 

After the first surgery incisions had healed enough, the patient came in for his second AKN-removal surgery. This time, Dr. Umar removed the patient’s smaller plaque and the much more minor AKN bumps on his head.

Figure 3 Dr. Umar surgically removed the AKN plaques and the bumps from the patient’s head.*

 

 

Dr. Bumpinator Pools out the Laser from his Tool Box for an AKN Coup De Grace

For the final task of mopping up the remaining satellite lesions, Dr. Bumpinator resorted to his laser toolbox. The doctor figured five laser sessions would be necessary for this particular patient. Those sessions were spread apart by 6-8 weeks each. Since ingrown hairs often trigger AKN, laser is an effective treatment for AKN bumps because it destroys the roots of those trapped hair follicles. Doing so addresses the cause of AKN instead of just alleviating its symptoms. 

 

Below are the patient’s excellent AKN surgery results with long and short haircuts. 

Figure 4 Only 9  months post-surgery, the patient’s scar is already looking much better. *

 

Figure 5 1 year and 8 months after his removal surgery and the scar is healing so well, the patient feels comfortable enough to have a short haircut. *

 

The patient was pleased with how his AKN-removal surgery results turned out. Living with the painful and visually unappealing plaques and finally getting those removed brought him a fresh breath of air.

The realization that he could even have a short haircut and not worry about people seeing the AKN bumps anymore was especially thrilling to the young man. He felt like he had a renewed sense of confidence and improved self-esteem.

 

Watch Dr. Umar administer a laser treatment after surgically removing the patient’s AKN lesions.

 

 

Frequently Asked Questions

 

Will antibiotics treat my AKN razor bumps?

Antibiotics can help if you have developed a bacterial infection due to your AKN. Doxycycline and minocycline are examples of antibiotics that have an additional anti-inflammatory effect. Antibiotics, in general, would only result in temporary relief and are not expected to result in a long-term resolution.

You should see a specialist who would determine the best long-term curative method for your specific presentation. 

 

What are some signs of AKN worsening?

If your AKN bumps are getting bigger and/or merging, it is a clear sign that your AKN is growing in severity. The longer you wait, the more problematic the bumps will get. You should be diagnosed and treated as soon as possible.

 

References 

  1. Umar S, Lee DJ, Lullo JJ. A Retrospective Cohort Study and Clinical Classification System of Acne Keloidalis Nuchae. J Clin Aesthet Dermatol. 2021;14(4):E61-E67.
  2. 21 Types of Skin Lesions, Pictures, Causes, and More. Healthline. https://www.healthline.com/health/skin-lesions. Published 2022. Accessed August 3, 2022.