Acne Keloidalis Nuchae

Key Points
Chronic skin condition characterized by inflamed follicular based bumps (Folliculitis) and Scars on the neck
Not related to common Acne, but can appear as acne-like lesions on the nape of the neck and base of the scalp
Can result in large Scars, called keloids

Acne keloidalis nuchae (AKN, also known as Keloidal Folliculitis or Nuchal Keloidal Acne) is a chronic condition in which hair follicles at the nape of the neck and base of the scalp become inflamed (Folliculitis). As the condition progresses, what begin as small bumps become larger and more painful. Without treatment this can lead to severe scarring of the affected area. The occurrence of this condition may be related to irritation from shaving, skin infection, or immune system problems. Acne keloidalis nuchae is most commonly seen in young adult black men, but is also found in young adult men of Latino and Asian descent in rare instances, but is very rare in women of any race. It is also rarely seen before the onset of puberty or after middle age.

AKN is sometimes associated with close shaving in the affected area, which leads to irritation of the skin. Appearing initially as red or pus-filled bumps which are tender and sometimes itchy, the condition can develop into small scars, and left untreated these scars can coalesce into large, thick keloids. This scarring can be accompanied by hair loss in the affected area. In advanced cases, sinus tracts can form from the skin surface to deep pockets of pus, leading to a foul smelling discharge.

Differential Diagnosis (Other conditions with similar appearance)
Acne Conglobata
Acne Vulgaris
Folliculitis decalvans
Other acneiform eruptions

Diagnosis
Key Points
Diagnosis is based on a combination of skin appearance and cultures of the lesions
Biopsy may be required to rule out other conditions

AKN is diagnosed through a combination of skin examination and testing cultures taken from the lesions themselves. A Biopsy of the affected area may be needed by health care professionals to rule out conditions with similar appearance.

Treatment

Immediate treatment is recommended to avoid excessive scarring and Hair loss in the affected areas
Self care options include avoiding irritation to the affected area from shaving and the use of head wear and shirt collars that contact the area.
Health care professionals may prescribe topical or oral treatments to alleviate symptoms and reduce swelling and scarring

OTC Options: Non-irritating skin Cleansers, cortisone cream

While it is recommended that those suffering from AKN seek help from health care professionals to halt the progress of the condition and prevent scarring and hair loss, self care treatments do exist. Washing the affected area very gently with non irritating cleansers, avoiding irritation to the area, and using an OTC cortisone cream to reduce itchiness can help to avoid the formation of additional lesions. The hair in the affected area should be left 1/4 inch long or longer. When the hairs are shaved this causes ingrown hairs and worsening of the condition.

Health care professionals have a number of options in the treatment of AKN. Topical solutions such as topical prescription strength steroid or cortisone preparations, and topical antibiotics such as Clindamycin can reduce the appearance of lesions, as well as the use of oral medications such as antibiotics. In severe cases, affected persons may be prescribed a short course of steroids, such as Prednisone. Treatments which reduce inflammation and reduce or remove scar tissue include steroid Injections, surgical excision of solitary scars and bumps, laser destruction, and Cryotherapy (the use of liquid nitrogen to freeze the scar tissue and remove it).

Written by Chris Schach