Acne Keloidalis Nuchae

Acne keloidalis nuchae (AKN) also known as keloidal folliculitis is a common chronic skin condition that presents as acne-like bumps, although it is not related to common acne (acne vulgaris). Initially it presents with intense inflammation and pus-filled bumps on hair follicles of scalp and neck that develop into small scars without treatment. With time, small scar progress into large, thick scars called keloids, with permanent hair loss.  Tufted "doll hairs," multiple hairs coming out of one opening may also be seen. Patients complain of itch and pain. AKN .The cosmetic disfigurement from AKN is the main contributing factor to low quality of life. 

Who is at risk?

AKN typically occurs in young adult males of African ancestry, but also occasionally develops in females and in non-African ethnic groups like Latinos and Asians. It is rare prior to puberty or after middle age.

Causes of AKN

The proposed theories focus on skin injury and body's abnormal immune response. Constant irritation of hair follicles from trauma of close shaving or clipping, friction from shirt collars, helmets and hats, as well as heat and humidity can predispose individuals to AKN.

Treatment of AKN

AKN is a chronic disease characterized by periodic flares of worsening inflammation. All treatment regimens require a maintenance regimen with adjustments for flares. Treatment is aimed at behavioral counseling of patients to avoid potential exacerbating factors and to improve active inflammation. With time, the inflammation subsides but the keloidal scarring persists.

  • Behavioral modification: 

    • Avoid picking, rubbing, or scratching the affected area

    • Discontinue close shaving, trimming, or razor- or clipper-edging of the posterior hairline

    • Avoid irritation from tight-fitting hats, helmets, or high-collared shirts

  • Treatment of inflammation:

    • High potency topical steroids​, topical retinoid and topical antibiotics

    • Oral antibiotics for severe inflammation and crusting

    • Intralesional steroid injections for persistent inflammation

    • Laser Hair Removal to help with inflammation and scarring

    • Oral isotretinoin for severe disease that does not respond to above options

  • Treatment for persistent scarring and keloids

    • Surgical excision for refractory disease or extensive keloidal scarring​

Depending on the severity of your symptoms, your dermatologist can formulate a treatment plan best for your clinical presentation and lifestyle.

(Image sourced from VisualDx.com linked here)