Acne Keloidalis Nuchae (AKN) is also referred to as Folliculitis Keloidalis, Folliculitis Keloidalis Nuchae, and simply Acne Keloidalis. Some authors point out that this is a follicular disorder and has nothing to do with acne. It is a chronic condition that affects the nape of the neck which progresses to keloidal scarring and associated alopecia. I like to use AKN terminology for historical reasons, but I certainly understand the hesitation of some authors based on disease origin. Initially, itchy round small bumps appear within or close to the hair-bearing areas of the occipital portions of the neck. These “itchy” papules can progress and scratching can promote keloid formation and promote secondary infections.
ETIOLOGY: It has long been known that close hair cuts and shaving of the scalp and posterior neck promotes this disorder. AKN is most commonly found in dark-skinned individuals and mostly in men. When I was in the military I saw this often and had to give out shaving and hair cutting profiles to keep the hairs out at least a quarter inch. It is thought to be related to a mechanical injury to the hair follicle, possibly due to rupture of the follicular lining. Hair is foreign material and when exposed to dermal tissue induces scarring and inflammation. It is also not uncommon for hairs to be tufted, having multiple hair shafts emerging from a single opening.
TREATMENT: It is very difficult to treat, but a number of options are available. Management includes making sure that clothing and equipment, such as high collars and helmets, do not rub or irritate the neck region. I always recommend to patients to avoid cutting the hair shorter than a quarter of an inch. Topical steroids, such as flucinonide are very helpful in managing the “itching” and often flattens the lesions. Intralesional steroids are also often effective. Oral tetracyclines help as an anti-inflammatory and help prevent secondary infections. Other antibiotics such as clindamycin and rifampicin can be used. Other systemic treatments include isotretinoin.
Surgical treatment (photograph above) may be required to remove large keoidal regions. Laser vaoporization and even electrosurgery may be helpful. Laser-assisted hair removal may also be helpful.