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KEY POINTS
Acne keloidalis nuchae (AKN) initially presents as a folliculitis that often develops into keloid-like papules and plaques.
AKN occurs in patients with darkly pigmented skin of color with coarse, curly hair, usually after puberty.
Although the older literature implies that AKN only occurs in males, it can also occur in females.
Therapy can be medical, surgical, or a combination of both.
Excision with second-intention healing is the optimal surgical modality, but the cosmetic outcome can vary.
The application of a class I or II topical corticosteroid is the recognized standard medical therapy.
Long-pulse diode laser or long-pulse neodymium-doped yttrium aluminium garnet (Nd:YAG) laser therapy may significantly improve some AKN lesions.
Initiating treatment as early as possible achieves the best results and improves the likelihood of controlling the disease.
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Acne keloidalis nuchae
Dermatitis papillaris capillitii
Keloidal folliculitis
Sycosis nuchae
Folliculitis keloidalis nuchae
Folliculitis nuchae scleroticans
Nuchal keloid acne
Keloid acne
Folliculitis keloidalis
Folliculitis barbae traumatica
Sycosis framboesiformis
Lichen keloidalis nuchae
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Acne keloidalis nuchae (AKN) refers to the formation of keloid-like papules and/or plaques on the occipital scalp and posterior neck almost exclusively in darker-pigmented men with coarse, curly hair.1,2 It usually starts after puberty as an acute folliculitis and perifolliculitis that becomes chronic. As the disease progresses, the papules enlarge to form keloid-like plaques. Associated scarring alopecia is common in the involved scalp area.
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AKN was first described by Kaposi in 1869 as dermatitis papillaris capillitii, one of the older synonyms for AKN.3 This name was based on the anatomic location of acne keloidalis; the capillitium is the suboccipital portion of the skin. Three years later, Bazin named the disorder acne keloidalis, a designation that still prevails today.4
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The older literature implies that AKN only occurs in males, but we now know that it can occur in females, with a male-to-female ratio of approximately 20:1.5 Although, AKN is found predominately in darker-pigmented men with coarse, curly hair, the next most common group with AKN is Hispanics followed by Asians; Caucasians develop it least often.6
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ETIOLOGY AND PATHOGENESIS
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The exact cause of AKN is unknown. It does not represent acne vulgaris, nor is it a true keloid. AKN lesions are not comedonal in comparison to acne lesions. Acute folliculitis and perifolliculitis usually precede AKN, followed by chronic folliculitis and then AKN. Systemic antibiotics may cure the folliculitis but do not soften or clear the existing keloid-like lesions. AKN may respond to systemic steroid therapy.6
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George et al6 found that 15% of their patients had a family history of AKN. As in pseudofolliculitis barbae (PFB), shaving short, tightly curled hair, which is common among darker-pigmented men, and then having the new hair growth curve back to penetrate the skin may be the precipitating factors. ...