Acne Keloidalis Nuchae

Acne keloidalis nuchae (AKN) is a chronic inflammatory condition which affects hair follicles on the back of the scalp. It is most commonly seen in men of Afro-Caribbean descent although it can also affect patients of Hispanic, Asian, Middle Eastern and Mediterranean backgrounds. In rare cases, it may also be seen in Caucasians. The term AKN is misleading because the condition does not form true keloid scars and is not associated with acne.

What causes acne keloidalis nuchae of the scalp?

The cause of AKN is unknown. Possible precipitating factors include frequent short haircuts, close shaving, chronic trauma (e.g., rubbing of shirt collar on the neck), curly hair and ingrown hairs.

What are the symptoms and signs of acne keloidalis nuchae?

Acne keloidalis nuchae is often associated with symptoms such as itching, pain or burning. It usually affects the back of the scalp.
In the early stages of AKN, small firm bumps, pimples, pus-filled spots and crusts form around the hair follicles on the back of the scalp. As the condition progresses, the bumps enlarge, coalesce and eventually form scar-like areas. Tufting i.e., the emergence of several hair shafts from the same opening in the skin, may be seen. Destruction of hair follicles in AKN results in irreversible hair loss.

How is acne keloidalis nuchae diagnosed?

Acne keloidalis nuchae can often be recognised by its characteristic appearance and distribution. However, if the diagnosis is uncertain, a biopsy may be performed.

How is acne keloidalis nuchae treated?

The treatment of AKN may include:

  • Intralesional corticosteroids
  • Topical antibiotics e.g., clindamycin
  • Oral antibiotics e.g., doxycycline
  • Dapsone
  • Isotretinoin
  • Biologics e.g., adalimumab
  • Surgery

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