Acne Keloidalis Nuchae

Acne keloidalis nuchae (AKN), also known as keloidal folliculitis, is a common chronic skin condition that presents as acne-like bumps but is not related to common acne (acne vulgaris). Initially AKN presents with intense inflammation and pus-filled bumps on hair follicles of scalp and neck that develop into small scars if not treated. Over time the small scars progress into large, thick scars called keloids that cause permanent hair loss in the affected area. Tufted “doll hairs” or multiple hairs coming out of one opening may also be observed. Symptoms associated with AKN include itch and pain in the affected area, but 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 the 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 to improve active inflammation and includes behavioral counseling of patients to avoid potential exacerbating factors. With treatment, the inflammation of AKN can subside but 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 retinoids, 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, our dermatologists can formulate a treatment plan best for your clinical presentation and lifestyle.

​Image sourced from VisualDx.com linked here