{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T08:41:28Z","timestamp":1790757688217,"version":"4.1.0"},"reference-count":18,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2019,10,23]],"date-time":"2019-10-23T00:00:00Z","timestamp":1571788800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Dermatology"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Acne keloidalis (AK) is one of the primary cicatricial alopecias and predominantly affects men of African descent. Reports in Asians are scant. This study aimed to retrospectively review the clinical and histopathological features of AK patients in southern Taiwan and identify the pathognomonic features of AK. There were 15 patients with histopathologically confirmed AK in National Cheng Kung University Hospital between 1988 and 2018. The median onset age was 24\u00a0years (range, 14\u201371). The male\u00a0:\u00a0female ratio was 14:1. In the acute stage of AK, the lymphocytic and neutrophilic peri\u2010infundibular inflammatory infiltrates with microabscess formation and edema corresponded to the clinical finding of isolated papules or pustules. Subsequently, the inflammatory infiltrates involved the mid\u2010dermis and the isthmus of hair follicles. The \u201cspade sign\u201d, a thin and dilated space resembling the shape of a balloon or spade symbol of playing cards at the level of lower isthmus, was identified in eight biopsies from five patients and may be a pathognomonic sign in the subacute stage of AK. At the chronic stage, the segments of hair shafts remained in the upper to mid\u2010dermis and induced chronic inflammation and extensive fibrosis, resulting in the clinical keloid\u2010like appearance. The restriction of inflammation and fibrosis in the upper to mid\u2010dermis was another unique and pathognomonic feature of AK.<\/jats:p>","DOI":"10.1111\/1346-8138.15127","type":"journal-article","created":{"date-parts":[[2019,10,24]],"date-time":"2019-10-24T03:53:59Z","timestamp":1571889239000},"page":"41-46","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["\u201cSpade sign\u201d and inflammation\/fibrosis limited to the upper and mid\u2010dermis as the pathognomonic features of acne keloidalis"],"prefix":"10.1111","volume":"47","author":[{"given":"An\u2010Yu","family":"Cheng","sequence":"first","affiliation":[{"name":"Department of Dermatology National Cheng Kung University Hospital College of Medicine National Cheng Kung University Tainan Taiwan"},{"name":"Department of Dermatology Kaohsiung Chang Gung Memorial Hospital Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0848-0657","authenticated-orcid":false,"given":"Chaw\u2010Ning","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Dermatology National Cheng Kung University Hospital College of Medicine National Cheng Kung University Tainan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fu\u2010Nien","family":"Hsieh","sequence":"additional","affiliation":[{"name":"Department of Dermatology National Cheng Kung University Hospital College of Medicine National Cheng Kung University Tainan Taiwan"},{"name":"Department of Dermatology St. Martin De Porres Hospital Chiayi Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tzu\u2010Kun","family":"Lo","sequence":"additional","affiliation":[{"name":"Department of Dermatology National Cheng Kung University Hospital College of Medicine National Cheng Kung University Tainan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsin\u2010Yu","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Dermatology National Cheng Kung University Hospital College of Medicine National Cheng Kung University Tainan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4365-4533","authenticated-orcid":false,"given":"Chao\u2010Kai","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Dermatology National Cheng Kung University Hospital College of Medicine National Cheng Kung University Tainan Taiwan"},{"name":"International Center for Wound Repair and Regeneration National Cheng Kung University Tainan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia Yu\u2010Yun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Dermatology National Cheng Kung University Hospital College of Medicine National Cheng Kung University Tainan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3897-6522","authenticated-orcid":false,"given":"Chao\u2010Chun","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Dermatology National Cheng Kung University Hospital College of Medicine National Cheng Kung University Tainan Taiwan"},{"name":"International Center for Wound Repair and Regeneration National Cheng Kung University Tainan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,10,23]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1067\/mjd.2003.68"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/1346-8138.14217"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.2147\/CCID.S99225"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0189790"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.136.4.479"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000372-199004000-00001"},{"issue":"1","key":"e_1_2_6_8_1","first-page":"19","article-title":"Outer root sheath keratinization in anagen and catagen of the mammalian hair follicle. 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