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Therapeutic Approach

Acne keloidalis nuchae (AKN) is actually a misnomer—as it is not induced by acne, not histologically consistent with keloids and is not limited to the posterior neck. More accurately termed “folliculitis keloidalis,” it is a chronic inflammatory follicular disorder, primarily affecting Black men, which presents with persistent papules and, in some cases, keloidal-like plaques on the occipital scalp and upper posterior neck.1 It is associated with pseudofolliculitis barbae, chronic scalp folliculitis, an increased risk of new-onset hypothyroidism, hidradenitis suppurativa, acanthosis nigricans, keratosis follicularis spinulosa decalvans, and metabolic syndrome.2-8 Some individuals may have a genetic predisposition to developing AKN.9 It can be seen in patients on cyclosporine, diphenylhydantoin, and carbamazepine.10 AKN can be characterized based on location of the lesions on the scalp, morphology of the lesions (ie, discrete or merged papules or nodules, plaques, or tumorous masses), and whether there is associated dissecting cellulitis of the scalp (DC) or folliculitis decalvans (FD).11 Therapy should be tailored to the stage of development in each affected patient, and any concomitant infection, if present, should be treated. See Table 84-1.

Table 84-1Acne Keloidalis Nuchae Treatment Table

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