Acne Keloidalis Nuchae

What is keloidalis nuchae acne?

Folliculitis is the inflammation of a hair follicle, and acne keloidalis nuchae is a form of folliculitis. The back of your head and the nape of your neck are affected. Acne keloidalis nuchae is not a form of acne, despite its misleading name. Folliculitis keloidalis, acne keloidalis, and acne keloidalis nuchae are some of the other words for it.

Tiny, itchy bumps appear around the back of the neck and along the acne keloidalis nuchae’s hairline. The small spots become scars over time, and the hair in and around them falls out. The wounds gradually enlarge and take on the appearance of keloids. These wounds are rugged and raised.

What causes it?

Doctors don’t know what causes acne keloidalis nuchae, although it seems that some individuals are more susceptible to it than others. Males with darker skin, especially those of African descent, are more vulnerable Trusted Source. Men with stiff or curly hair are also more likely to grow it Trusted Source.

Although the exact cause is unclear, researchers have proposed a few theories:

  • Shaving in tight quarters. Near shaving injuries, according to others, cause inflammation, which kills the hair follicle.
  • Irritation is constant. Shirt collars and helmets can cause folliculitis and scarring if they cause inflammation or rubbing on the hairs regularly. Heat and humidity can aggravate the situation.
  • Medications in particular. Since taking cyclosporine, some people have developed acne keloidalis nuchae, according to credible reports. This medicine is used to treat psoriasis and rheumatoid arthritis. Antiepileptic medication use has also been related to the disease.
  • Mutations in the DNA. A mutation in the human genome It’s possible that a trusted source raises someone’s likelihood of getting a low hair follicle structure.
  • Infection that lasts a long time. Chronic, low-grade infections can also lead to the production of acne keloidalis nuchae Trusted Source.

What is the cure for it?

Acne keloidalis nuchae are notoriously tricky to handle. For some people, different methods perform better than others.

Laser therapy is a form of treatment that uses light:

Acne keloidalis nuchae have been treated with different forms of laser therapy. Laser hair removal can effectively treat mild cases of the disease. The hair follicle is destroyed, and the inflammatory response is reduced with laser and light therapy.

The majority of people need a few laser sessions spaced out over several weeks. Before you start laser therapy, your doctor may want to make sure you’re free of any infections. To get better results, they can prescribe topical steroids or retinoids in addition to laser therapy.


  • To treat acne keloidalis nuchae, your doctor can prescribe one or more medications, such as:
  • Topical steroids are used to treat small papules.
  • For any illnesses, antibiotics should be taken orally.
  • For significant, inflamed lesions, a short course of oral corticosteroids is prescribed.
  • injections of steroids for prominent papules.

Surgical procedures:

Your doctor can suggest surgery if your condition is severe and your scars are enormous.

Depending on the seriousness of your condition, you will have the following surgical options:

  • Surgical attack: This technique, also known as a skin punch or punch biopsy, involves puncturing the skin with a hollow, circular blade and removing the lesion. Anti-inflammatory medicine is applied to the wound, which is then stitched shut.
  • Surgical removal: This is a conventional surgery in which the lesion is removed with a scalpel. This technique is used to treat large lesions to avoid them from returning. The best way to treat this sort of surgical wound is to leave it open. Healing may take weeks or months.
  • An Electrosurgery is a form of surgery that requires the use of electricity: Electrosurgery, rather than using a scalpel to remove the lesion, uses a high-frequency electric current to cut through the tissue.

Are there any medications available over-the-counter?

Your doctor may prescribe some over-the-counter products as part of your acne treatment to help prevent the acne keloidalis nuchae from worsening.


Tar shampoo, also known as coal tar shampoo, belongs to the keratoplasty class of medicines. These medicines are used to treat a variety of itchiness in the skin. They cause the skin to shed dead skin cells while also slowing the development of new ones. This will help to reduce scratching and scaling.

Soaps are a form of soap:

To treat acne keloidalis nuchae, it’s vital to prevent infection. Using an antimicrobial cleanser on the infected area daily to keep it safe. Look for one with benzoyl peroxide, such as this one. A cleaner containing chlorhexidine, such as this one, may also be recommended by your doctor. Follow the doctor’s guidance for how much and how long to use it.

Tips for treating keloidalis nuchae acne:

Although it’s difficult to entirely remove acne keloidalis nuchae, these tips will help you keep it under control:

  • Wear collarless shirts and jackets that don’t irritate the hairline or nape of your neck.
  • Hair follicles can be affected by terse haircuts or close shaves.
  • Stop applying pomade, hair grease, or other similar items to your hair. They have the potential to obstruct hair growth.
  • Wearing hats or helmets that create rubbing along the back of your neck is not a good idea.
  • Maintain a clean and dry back of the neck. When cleansing your face, stop rubbing it too hard. As a result, your skin can become more irritated.

What is the prognosis?

While there is no cure for acne keloidalis nuchae, it can be handled by avoiding causes and following your doctor’s care advice.


Due to the frequent brisk bleeding associated with scalp incision, cold-steel excision is difficult. Pure electro section alone offers little or no benefit in this regard, but when settings are combined with damped coagulation waveforms, it helps to provide both a precise incision and help control bleeding along the wound edges.

Although wound stress after conventional primary closure can lead to early postoperative restrictions in neck flexion or even baseline neck extension, secondary purpose healing avoids these problems (SIH).

SIH also eliminates questions about wound dehiscence, which may hinder sutured closures. However, some studies have shown that postoperative pain is higher in wounds that are left open to heal than those covered exclusively with sutures. The need for oral analgesics in patients with SIH should be expected in the first few days following surgery.

Scar widening has also been identified as a late complication following AKN excision after primary closure.

This isn’t surprising, given that these wounds are frequently under a lot of strain when they’re closed. This degree of stress is undoubtedly exacerbated by the pressure associated with the region’s extraordinary mobility. Surprisingly, wounds on the posterior neck left open for SIH experience significant postoperative contraction, and their presence after healing often rivals that of wounds closed exclusively with sutures. Surprisingly, recurrence rates following AKN excision have been higher with primary closure than secondary purpose damage healing.

Product of the Patient:

After his excision, our patient rejected the need for analgesics. This is in contrast to a previous study that found that narcotic analgesics were needed for pain management in 4 of 4 AKN patients treated with electro surgery and SIH. We hypothesize that the hemostatic agent used to close the wound and avoid hemorrhage for our patient was also related to less early postoperative pain.

Our patient confirmed that his wounds were healed entirely eight weeks after the operation. At the age of 12 weeks, digital images were taken. The two large excision sites permitted to heal by secondary purpose had shrunk dramatically in size and were graded as “very appropriate” by the patient at 12 weeks. A small amount of slightly hypertrophic scar on the right was discovered during our study, but there was no other evidence of active AKN-related inflammation or persistent keloid-like scar. At the four-month follow-up, the patient had no recurrences.

In conclusion, although AKN can be stressful for patients, there are successful therapies available. Similar studies describing AKN excision accompanied by second-purpose healing have reported that electrosurgical excision produced a very satisfactory patient outcome. In this case, the use of a potassium ferrate-containing polymer as a hemostatic agent was well tolerated, and it may be helpful postoperatively in reducing oozing and preventing subsequent bleeding. Our patient’s post-operative pain tended to be lessened as well. More research is required to validate the hemostatic agent’s post-operative usefulness and protection in deeper wounds left to heal secondarily.

  • Dr. Torres is a dermatologist and a Mohs and cosmetic surgeon at Affiliated Dermatologists in Morristown, NJ. In a Procedural Dermatology Fellowship approved by the Accreditation Council for Graduate Medical Education, he also teaches Mohs surgery and cosmetic surgery (ACGME).
  • Dr. Lortie is a Mohs surgery fellow in procedural dermatology at Affiliated Dermatologists in Morristown, NJ.
  • Dr. Rogachefsky is a practicing dermatologist and the Program Director of Associated Dermatologists & Dermatologist Surgeons’ ACGME-approved Procedural Dermatology Fellowship Morristown, NJ.

The authors declare that they have no functional financial relationships.


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