A three-patient research observation links severe acne keloidalis nuchae, dissecting cellulitis and secondary cutis verticis gyrata, while biopsy findings suggest that clinically normal-looking scalp may also carry an inflammatory signature.
The most important clue may be hiding in scalp that looks normal. In the short video, Sanusi Umar, MD describes a recurring pattern documented in three patients: severe acne keloidalis nuchae (AKN) at the back hairline, dissecting cellulitis of the scalp (DCS) across the scalp and secondary cutis verticis gyrata (CVG), which produces deep scalp folds. The finding raises a practical point for examination: visible disease may not tell the entire story.
Three Conditions Appearing Together
The video distinguishes the three components of the pattern. AKN forms a scarring mass at the back hairline. DCS causes painful draining bumps and tunnels across the scalp. CVG creates deep, brain-surface-like folds of the scalp. In the study described by Dr. Umar, all three appeared in the same patients, pointing to a candidate syndrome that requires further validation.
“If we see one, we must search for the other.”
That statement captures the clinical message of the short video. Dr. Umar cautions against stopping at one visible diagnosis and missing another part of the scalp pattern. The supplied caption similarly emphasizes examining the entire scalp, including the nape, rather than focusing only on the areas where symptoms are most obvious.
PIILIF in Diseased and Normal-Looking Scalp
Biopsy findings added another layer. The materials describe PIILIF as inflammation and early fibrosis around the upper portion of the hair follicle. The same biopsy pattern appeared across AKN lesions, DCS lesions and clinically normal-looking scalp. Dr. Umar describes PIILIF as a possible common thread linking AKN and DCS, and the video presents it as a potential precursor that needs further study.
The importance of the normal-looking scalp finding is not that it proves a diagnosis by appearance. Rather, it supports the study observation that the inflammatory and fibrotic pattern was present even where the scalp did not look clinically affected. That is why the source materials frame complete examination and biopsy findings as important parts of understanding the candidate syndrome.
A Candidate Syndrome That Still Needs Validation
The research is presented as an identified pattern for further study, not as a settled conclusion. The caption explicitly notes that the findings do not mean every scalp bump will progress into these conditions and that larger studies are still needed to validate the proposed AKN-DCS-CVG syndrome. Within that limitation, the three-patient pattern and shared biopsy signature offer a reason to look carefully for overlapping disease when AKN, DCS or CVG is present.
The short video also stresses the value of early recognition and treatment. Its central message is straightforward: when one component of this pattern is found, clinicians should consider whether the others are also present rather than assuming the visible condition exists in isolation.
Watch the Short Video
Watch Dr. Umar explain the AKN-DCS-CVG pattern and the shared biopsy finding: YouTube Short
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Free ConsultationMedical disclaimer: This content is for educational purposes only and is not medical advice. Diagnosis and treatment should be individualized by a qualified healthcare professional.
Further Reading
- https://dru.com/acne-keloidalis-nuchae-dissecting-cellulitis-cvg-syndrome/
- https://dru.com/piilif-in-dissecting-cellulitis-what-paired-biopsies-reveal-across-normal-appearing-scalp-quiet-nodules-and-active-lesionspiilif-in-dissecting-cellulitis/
- Umar S, Ogah O, Yang J, Tan BH, Aiead N, Shitabata PK. A Candidate Syndromic Triad of Acne Keloidalis Nuchae, Dissecting Cellulitis, and Secondary Cutis Verticis Gyrata. Clin Cosmet Investig Dermatol. 2026 Aug 28;19:615576. doi: 10.2147/CCID.S615576. PMID: 42683347; PMCID: PMC13532648. https://www.dovepress.com/a-candidate-syndromic-triad-of-acne-keloidalis-nuchae-dissecting-cellu-peer-reviewed-fulltext-article-CCID
