Sometimes what we see on the skin is just the beginning of a bigger story. In today’s Derm Diaries, we meet a patient in his 30s with bumps and scarring on the back of the scalp and neck, known as acne keloidalis nuchae. Alongside this, he also has dark, thickened folds around the neck, armpits, and elbows. These changes tell us more than meets the eye—they hint at underlying health concerns like insulin resistance and metabolic syndrome.
• AKN is most common in men with coarse, curly hair.
• It begins with small itchy bumps or pustules on the scalp/neck junction.
• Shaving, friction from collars, or chronic irritation can worsen the inflammation.
• Without treatment, bumps can progress to scar-like plaques and permanent hair loss.
• Appears as dark, thickened, velvety patches in body folds (neck, armpits, groin, elbow creases).
• Often a sign of insulin resistance, type 2 diabetes, or obesity-related metabolic syndrome.
• Can also be triggered by certain medications or rarely by internal malignancies.
When AKN and acanthosis nigricans are seen together, it’s more than just a skin issue:
• AKN can signal chronic inflammation and scarring that affect quality of life.
• Acanthosis nigricans is a skin marker of systemic health, pointing to possible insulin resistance, high blood pressure, and elevated cholesterol.
• Together, they emphasize the importance of both dermatologic treatment and metabolic health evaluation.
For Acne Keloidalis Nuchae:
• Topical therapies: steroid lotions, retinoids, or antimicrobial washes.
• Procedures: laser hair removal, intralesional steroid injections, or surgical excision for severe scarring.
• Prevention: avoid close shaves, high-friction collars, and irritating haircuts.
• Focus on addressing insulin resistance through weight management, diet, and exercise.
• Metformin or other metabolic treatments may be prescribed by an internist or endocrinologist.
• Topical keratolytics (like urea or salicylic acid creams) may help improve skin texture.
This Derm Diaries case reminds us that the skin often reflects what’s happening inside the body. Acne keloidalis nuchae is not just a cosmetic concern—it can be a clue to underlying systemic health conditions, especially when paired with acanthosis nigricans.
If you notice persistent bumps on the back of your neck or thickened dark skin folds, it’s important to see a board-certified dermatologist. Treatment can help control inflammation, prevent scarring, and guide further evaluation for metabolic health.
Disclaimer: This case features an actual patient of Dermatology Solutions, shared for educational purposes with written patient consent. All patient images and content are protected under copyright. Reproduction, copying, or distribution without explicit written consent from Dermatology Solutions is strictly prohibited.