Acne Keloidalis Nuchae
Definition: Acne keloidalis nuchae (AKN) also known as folliculitis keloidalis nuchae (FKN) is a chronic debilitating condition that is characterized by keloid-life plaques that usually affects the occipital area or nape of the neck. Untreated AKN can lead to scarring folliculitis.
Epidemiology: Acne keloidalis nuchae is thought to predominantly affect men of African American descent but a few studies have shown it to significantly affect other ethnicities. It is seen in post-pubertal males and is uncommon beyond the age of 55.
Signs: Firm, flesh-coloured, pink or flesh-coloured papules and nodules may aggregate into sizable plaques resembling keloid. In the afflicted locations, these lesions frequently result in permanent hair loss and scarring.
Symptoms: Symptoms typically develop from a haircut or irritation from wearing a sports helmet and tend to appear a few hours to days after the irritation. In active lesions, pruritus, discomfort, and contact bleeding are frequent which may cause men to avoid haircuts.
Differentials: AKN is often mistaken for a keloidal condition and shares some features with cicatricial alopecia.
Diagnosis: Based mostly on the location and distinctive look of the lesions, the diagnosis is made clinically. In rare circumstances, a biopsy may be done to rule out other disorders.
Treatment: Treatment options include topical and intralesional corticosteroids, topical retinoids, topical antibacterials, oral antibiotics for secondary infections, and laser therapy. In refractory cases, surgical excision or radiation therapy may be considered as well as oral isotretinoin.
References: (AMA)
- Umar S, Lee DJ, Lullo JJ. A Retrospective Cohort Study and Clinical Classification System of Acne Keloidalis Nuchae. J Clin Aesthet Dermatol. 2021;14(4):E61-E67.
- Ogunbiyi A. Acne keloidalis nuchae: prevalence, impact, and management challenges. Clin Cosmet Investig Dermatol. 2016;9:483-489. Published 2016 Dec 14. doi:10.2147/CCID.S99225
- Maranda EL, Simmons BJ, Nguyen AH, Lim VM, Keri JE. Treatment of Acne Keloidalis Nuchae: A Systematic Review of the Literature. Dermatol Ther (Heidelb). 2016;6(3):363-378. doi:10.1007/s13555-016-0134-5