What’s not in a name?
This is actually a chronic staphylococcal folliculitis of the posterior scalp and the nape of the neck, which leads to thick hypertrophic scars rather than true keloids. The condition is usually seen in African Americans who are more susceptible to true keloids. This man is a rather overweight coal miner, and overlapping folds of fat and chronic dust and sweat exposure resulted in a chronic infective process. Weight loss and a different work environment would help the most, but antibiotics such as Minomycin can also help reduce the infective and inflammatory tendencies.