What to learn about recent research in acne keloidalis? click here.

What is acne keloidalis nuchae (AKN)? 

  • This is a scarring process that occurs on the back of the neck
  • The condition occurs most commonly in young black men 
  • It consists of itchy bumps.
  • The bumps are sometimes painful and drain fluid. 

What is the cause of acne keloidalis nuchae?

  • The exact cause is not known but it is thought to be due in part to the inward growth of curved hairs that are more common in black men and those with afro-textured hairs.
  • This may be due to short hair cuts or chronic irritation from collared shirts or athletic gear.

How is the diagnosis of acne keloidalis nuchae made?

  • If there is any fluid draining, a swab will be taken
  • Usually the biopsy can be make by visual inspection. A biopsy is usually not needed.

How is acne keloidalis nuchae treated?

  • It is advisable to try to avoid wearing your hair too short.

  • Growing it out a bit can be very helpful.  

  • It can also be helpful to avoid wearing tight  fitting collared shirts as much as possible.

In addition, one or more of the following may be prescribed:

  • 2 % clindamycin powder (an antibiotic) in DILUSOL
  • 2 % hydrocortisone cream
  • Short term use of topical steroid such as Clobetsol cream
  • Tretinoin 0.01 % or 0.025 % cream with a topical steroid is often a useful combination

  • Topical chloramphenicol has been effective and can be prepared by adding 500 mg to 30 g of fluocinonide cream

  • Antibitoic pills such as doxycyline can also be used if a lot of drainage is present

  • Sometimes injection of steroids can be performed, sometimes with shaving off of the bumps before injecting the steroids. You need to be aware the lightening of the skin can sometimes occur for a period of 6-12 months with steroid injections

  • Sometimes deep punch excisions can be done and closed with silk suture

  • If AKN is very troublesome and resistant to treatment, isotretinoin can be prescribed.

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