Acne Keloidalis Nuchae

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Basics ⬇

The name acne keloidalis nuchae (AKN) is actually a misnomer. AKN has nothing to do with acne but is actually a type of folliculitis similar to PFB.
The pathogenesis of acne keloidalis is similar to that of pseudofolliculitis barbae (see previous section), in which coiled hairs pierce the skin resulting in an inflammatory reaction.

Clinical Manifestations ⬆

Initially, inflammatory acneiform papules and pustules are noted.
Ultimately, hypertrophic scarring occurs, characterized by flesh-colored to pink firm papules (Fig. 19.24) and possibly extensive keloid formation (Fig. 19.25).
This condition is characteristically seen in the lower occipital area, but it can extend to the adjacent scalp or cover the entire scalp and thus may be indistinguishable from folliculitis decalvans.

Differential Diagnosis

As with PFB with which it may coexist, acne vulgaris and folliculitis may be difficult to distinguish from AKN.

Management

Potent topical or intralesional steroids (5 to 10 mg/mL) help decrease itching and inflammation.
Topical antibiotics are used when papules and pustules are present.
A systemic antibiotic such as minocycline or doxycycline are helpful because of their anti-inflammatory effect.
Surgical treatment is not without risk. It is reserved for extreme cases and may result in worse scarring.

Helpful Hints

When bacterial folliculitis is present, it is usually the result of secondary, not primary, pathogens.
Prevention of these disorders also depends on avoidance of close “clipper” shaves and haircuts.