Acne keloidalis nuchae
- Julian M Mackay-Wiggan, MD, MS
Julian M Mackay-Wiggan, MD, MS
- Associate Professor of Dermatology
- Columbia University Medical Center
- Sameera Husain, MD
Sameera Husain, MD
- Associate Professor of Dermatology in Pathology
- Columbia University Medical Center
Acne keloidalis nuchae (AKN) is a common chronic disorder involving inflammation and scarring of the hair follicles with subsequent development of keloid-like papules and plaques and scarring alopecia. The characteristic site of involvement is the posterior scalp and neck. Infrequently, other areas of the scalp are affected.
AKN typically occurs in males of African ancestry, but also occasionally develops in females and in non-African ethnic groups. AKN may be pruritic, painful, or cosmetically disfiguring, contributing to negative effects on quality of life.
The clinical features, diagnosis, and management of AKN will be reviewed here. Other hair and scalp disorders are reviewed separately. (See "Evaluation and diagnosis of hair loss".)
Although the term "acne keloidalis nuchae" is commonly used, there are other historical and contemporary descriptors for AKN. Historical terms for this condition include "sycosis framboesiformis" and "dermatitis papillaris capillitii" [1,2]. Contemporary alternative names for AKN include "folliculitis keloidalis" , "folliculitis nuchae" , and "folliculitis keloidalis nuchae" . In addition, because of the occasional extension to other areas of the scalp, some authors eliminate "nuchae" from AKN and refer to the disorder as "acne keloidalis."
Multiple authors have suggested that the name "acne keloidalis nuchae" is a misnomer, since the lesions are neither pathologically acne nor keloids . In contrast to true acne, comedones are never present in AKN . The scar-like lesions, though they resemble keloids, do not typically recur following excision like keloids often do , and patients typically do not have keloids elsewhere.
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- CLINICAL MANIFESTATIONS
- CLINICAL COURSE
- DIFFERENTIAL DIAGNOSIS
- Approach to treatment
- Avoidance of exacerbating factors
- Treatment of inflammation
- - Mild to moderate inflammation
- Topical corticosteroids
- Adjunctive therapies
- - Topical antibacterial agents
- - Topical retinoids
- - Moderate to severe inflammation
- Oral antibiotics
- Intralesional corticosteroids
- - Refractory inflammation
- Laser hair removal
- Oral isotretinoin
- Treatment of keloidal scarring
- - Papules and small plaques
- Intralesional corticosteroids
- - Larger plaques
- Emerging therapy
- - Ultraviolet light
- SUMMARY AND RECOMMENDATIONS