Prevalence of acne keloidalis nuchae in football players,☆☆

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Abstract

Background: Acne mechanica (AM) is common in football players. Severe cases of nuchal AM may precede acne keloidalis nuchae (AKN). Factors that may be associated with the progression of nuchal AM to AKN are unknown. The prevalence of AKN in football players has not been reported. Objective: We investigated the frequency of nuchal AM and AKN within a susceptible population and attempted to identify factors that may be associated with AKN. Methods: Four hundred fifty-three high school, collegiate, and professional football players were examined for the presence of nuchal AM or AKN. Those with positive findings completed a questionnaire regarding their disease. Results: Nuchal AM was more prevalent in high school players (15.5%) than older players (1.2%). AKN was more frequent in players beyond the high school level and was found exclusively in blacks. AKN was not associated with a positive family history of AKN nor a positive personal or family history of keloid formation. Conclusion: AKN occurs almost exclusively in blacks. The level of football play may be associated with the development of AKN. Positive family history of AKN and positive family or personal history of keloids is not associated with AKN development. (J Am Acad Dermatol 1997;37:570-4.)

Section snippets

MATERIAL AND METHODS

A total of 453 subjects, all male, were recruited from eight different groups: members of four local public high school football teams (grades 9 through 12, n = 135), collegiate football players from two state universities and the National Football League (NFL) scouting combine (n = 245),*

RESULTS

A total of 453 football players between the ages of 14 and 27 were examined. Players at or below the twelfth grade (level I) numbered 135. Players above the twelfth grade (level II) numbered 318 (Table I) . A total of 64 players had positive findings, and all completed evaluable questionnaires.

The prevalence of either nuchal AM or AKN was 14.1% for the entire group. The prevalence of nuchal AM in the absence of AKN was 5.9% for all players (5.5% in blacks, 6.6% in whites). The prevalence of AKN

DISCUSSION

In football players, nuchal AM has been noted to precede AKN. 5, 7 The padding within the football helmet provides an ideal environment for AM to develop. Heat and perspiration are trapped, Staphylococcus albus and Propionibacterium acnes are present, and friction and irritation are continuous. 6 Adding the increased sebaceous activity of this age group and their increased physical and emotional stress, football players would appear to be a population at increased risk for AM and possibly AKN.

CONCLUSION

We are the first to report the prevalence of AKN among a population at increased risk for this disease. Among 453 players examined, AKN was found exclusively among blacks. In addition to race, increased level of play was positively associated with the development of AKN. In the absence of a control population, we cannot state with confidence that this is not a phenomena associated with increased age such as increasing hair coarseness. It may simply be a matter of chance, that is, the older a

Acknowledgements

In addition to the players and coaches who participated in this study, we would like to thank the following for their help: Kenneth Dawes, MD, Brian Williams, MD, Leroi Keyes, MD, and Mary Morgan.

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    Citation Excerpt :

    The role of interleukin 1 alpha (IL-1α) in the pathogenesis of acne mechanica has been studied and non-comedonal (acneiform) lesions developing from excessive pressure have been termed “folliculitis mechanica” by some researchers.435,437 A wide variety of acne mechanica can be seen from detrimental skin friction or pressure in sports, music, neurology (i.e., tics) and others that include over-zealous skin washing, wearing tight leotards or helmets as well as other clothes or devices.434,438-441 Occupational forces may arise as seen in back pressure in truck drivers, exposure to coal-tar and others are forms of occupational acne.434

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