OSCE — Acne keloidalis nuchae (folliculitis keloidalis nuchae)

Brief (to candidate)

You will assess a patient with a presentation consistent with Acne keloidalis nuchae (folliculitis keloidalis nuchae).
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.

Clinical context

Acne keloidalis nuchae (AKN) is a chronic scarring folliculitis of the nape of the neck and lower occipital scalp that produces firm keloidal papules, coalescent keloidal plaques, tufted hairs, sinus tracts and permanent scarring alopecia. It almost exclusively affects young men of African descent with tightly curled hair and is triggered by close clipping of the nape, friction from collars and helmets, and ingrown hairs. Despite the misleading name, AKN is a chronic follicular scarring process rather than true acne, and the keloidal plaques are fibrotic scars rather than true keloids. Management is stepwise: counsel against close shaving and friction, high-potency topical and intralesional corticosteroids for limited disease and recurrences, and surgical excision with primary closure for extensive refractory plaques.

Candidate tasks

1. Clarify onset, severity, associated features, and red-flag symptoms.
2. State focused examination priorities.
3. List first-line investigations and any named score/criteria.
4. Give immediate resuscitation steps.
5. Outline definitive management with doses/routes where standard.
6. Name complications and disposition (ward / HDU / theatre / discharge safety-net).
7. Mention one special-population modifier (pregnancy, child, elderly, CKD).

Examiner checklist

Model outline

Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.^[1]