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What Is Acne Keloidalis Nuchae?

Medically Reviewed by Dan Brennan, MD on June 01, 2021

Acne keloidalis nuchae, also known as keloidal folliculitis, is a long-term or chronic inflammatory condition. It can lead to lesions, or sores, that appear on the nape of the neck and can turn into scars.

Acne keloidalis nuchae can be triggered by trauma, friction, or an infection. Read on to learn more about acne keloidalis nuchae, how to treat it, prevent it, and more.

What Is Acne Keloidalis Nuchae?

Acne keloidalis nuchae or keloidal folliculitis is a long-term or chronic skin condition that can lead to scars that develop on your neck. It’s most common in young men of African descent and typically starts after adolescence. 

Women can also develop this condition, but it occurs 20 times more frequently in men than in women.

Acne keloidalis nuchae develops on areas of your neck where hair grows. Tufted hairs, ingrown hairs, and broken hair shafts can be seen bordering the scars and blisters that appear when you have this condition.

Scars that develop as a result of acne keloidalis nuchae are often keloid-like, which means they are stiff and raised.

How It Develops

Acne keloidalis nuchae develops when inflammatory cells go into your hair follicles on your neck, leading to damage of the follicle wall and the sebaceous or oil-secreting gland

This ruptures the follicle and kickstarts the inflammatory process. This eventually leads to the thickening and scarring of your skin tissue (fibrosis).

Symptoms

Acne keloidalis nuchae often starts with inflamed rashes called papules. They come with erythema, or redness, and can eventually develop into pustules, which are blisters or pimples containing pus. Papules can also develop into tender, pus-filled masses called abscesses due to infection.

Over time, inflammation will lead to the formation of keloid scars and the papules will fuse into large plaques, which are broad, raised areas on your skin.

Causes

The exact causes of acne keloidalis nuchae are not known. However, research suggests that skin injury and immune reactions are the main reasons you can develop this condition.

Skin injuries from the following may also be risk factors for developing acne keloidalis nuchae:

  • Haircutting
  • Friction
  • Irritation
  • Trauma

Getting your hair cut at a barbershop is a risk factor you should be especially cautious about since people with the condition can pass it on to you. Specifically, the infection can be spread to you through blood, since active acne keloidalis nuchae lesions bleed during haircuts and shaving tools are often shared at the barbershop.

Wearing certain types of headgear may also cause acne keloidalis nuchae. Research has shown that African-American footballers who wore headgear for protection were more likely to develop the condition.

Additionally, androgens, or male hormones, may play a role in the development of this condition. It rarely appears before puberty and after the age of 55. Androgens may boost the ability of sebaceous glands to produce oil, making it easier for your hair follicles to get irritated and inflamed.

Diagnosis

Your doctor will determine if you have acne keloidalis nuchae by examining you. Laboratory studies may also be done to look for bacteria. If your doctor finds bacteria, they will prescribe you antibiotics as needed.

A biopsy may also be done to see if you actually have acne keloidalis nuchae or another condition such as cancer, psoriasis, or a severe type of acne called acne conglobata.

Treatment

There are multiple ways to treat acne keloidalis nuchae. Traditionally, the focus was on managing and preventing the condition. There is also the option to remove the abscess and scars through surgery and skin grafting if needed. 

Recently, laser and light therapies have also emerged as popular ways of treating this condition.

Managing and preventing acne keloidalis nuchae. To prevent and manage the condition, you can wear clothes that don’t touch your neck, since irritation from clothing can worsen the condition.

Additionally, you should avoid frequent haircuts and stop wearing accessories such as neck chains.

You can also use antimicrobial cleansers, steroids, retinoids, and/or antibiotics on your acne keloidalis nuchae to prevent infection and decrease inflammation.

Surgery. If your acne keloidalis nuchae has progressed to an advanced stage, you may consider getting surgery or skin grafts to treat the condition. This requires long periods of healing.

Several risks come with getting surgery for acne keloidalis nuchae. A study showed that 17 out of 31 patients who underwent surgery to remove their acne keloidalis nuchae had mild recurrence.

Laser and light therapies. In recent years, laser and light therapies have emerged as alternatives for surgery. They seem to work by decreasing the inflammation and/or destroying your hair follicle.

The most common forms of laser and light therapies include treatments with a specific kind of laser, called a 1064-nm Nd:YAG, and a tUVB light. Research suggests that the 1064-nm Nd:YAG laser and 810 diode laser are particularly effective at treating acne keloidalis nuchae, with good responses ranging from 82% to 95% effectiveness. 

tUVB was less effective, with responses ranging from 34% to 49%.

WebMD Medical Reference

Sources

SOURCES:

Al Aboud, D. and Badri, T. StatPearls: Acne Keloidalis Nuchae. StatPearls Publishing 2021.”

Clinical, Cosmetic and Investigational Dermatology: “Acne keloidalis nuchae: prevalence, impact, and management challenges.”

Dermatology and Therapy: “Treatment of Acne Keloidalis Nuchae: A Systematic Review of the Literature.”

Medscape: “Acne Keloidalis Nuchae (AKN).”

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