When John came to Dr. Sanusi Umar with acne keloidalis nuchae, dissecting cellulitis of the scalp, and cutis verticis gyrata, the challenge was not simply identifying each condition. In The Baldcast, Episode 6, Chapter 11, Dr. U describes how unusually advanced all three were in the same person, and why careful clinical thinking mattered.
Three Advanced Conditions in One Patient
Dr. U tells John that his presentation stood out even when each condition was considered separately. He describes the acne keloidalis nuchae as among the most advanced he had encountered, and says the same of the dissecting cellulitis and cutis verticis gyrata. He briefly describes cutis verticis gyrata as folding of the scalp.
What made the consultation especially unusual was their combination. As Dr. U puts it, John was “in the extreme on all of them.” That assessment comes from the physician’s discussion in this chapter, not from a comparison of photographs or a prediction about what would happen next.
Looking Beyond What Was Visible
Dr. U recalls seeing John’s lesions and consciously shifting his attention from their appearance to understanding how the conditions had developed and what might be needed. The distinction is central to his account: recognizing a difficult presentation is only the beginning of deciding how to approach it.
He describes having to move his “professional mind” away from what he was seeing and toward the underlying questions. The chapter does not lay out a treatment plan or document a result. Instead, it captures the thinking that comes before any such conclusion.
Why Dr. U Remained Hopeful but Cautious
Despite the complexity, Dr. U says the team maintained an optimistic outlook. He explains that patients should not have to see their doctor appear defeated by the challenge in front of them. His hope, however, was not a guarantee.
“From experience we felt hopeful,” he says, while adding that “you can never be too sure.” The two thoughts belong together: experience can support optimism, but an unusual combination of conditions still requires humility about what may be possible.
Chapter 11 leaves viewers with the challenge Dr. U faced at that moment: how to approach three advanced conditions together while staying attentive to uncertainty. The discussion continues in the next chapter.
Watch the Chapter
The Baldcast | Episode 6, Chapter 11
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Medical Disclaimer
This article is for educational purposes only and does not replace individualized medical evaluation, diagnosis, or treatment. No outcome is guaranteed.
Further Reading
- https://dru.com/john-acne-keloidalis-nuchae-loss-of-hope/
- 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
