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Acne keloidalis nuchae: Causes

Research suggests that acne keloidalis nuchae may be most common in Black American men who play football and wear a helmet

It is also common in Black men who wear a durag or hard hat and Black men who serve in the military and are required to keep their hair short.

Black men who wear a football helmet may have a greater risk of developing acne keloidalis nuchae

What causes acne keloidalis nuchae?

Many men believe that they get acne keloidalis nuchae (AKN) when their barber uses dirty clippers. This is a myth. You cannot catch AKN from clippers or scissors. AKN isn’t contagious.

AKN develops when inflammation develops inside hair follicles (openings in the skin and scalp where hair grows from) on the back of the neck, scalp, or both.

Inflammation is designed to help the body heal from an infection or injury like a sprained ankle or cut. Once the body heals, the inflammation stops.

Exactly why inflammation develops when someone has AKN is still a bit of a mystery. In studying this condition, dermatologists have learned that the inflammation is long-term. This long-term inflammation weakens hair follicles, so a hair inside a weakened follicle may pop out and burrow into the skin. As hairs continue to penetrate the skin, small bumps appear.

Without treatment, the inflammation continues. In time, scars cover the hair follicles. Once a hair follicle scars over, the follicle can no longer grow hair. This leads to permanent hair loss. As follicles continue to scar over, keloid-like scars appear.

While there is still more to learn about AKN, dermatologists have discovered that the skin on the back of the scalp or neck can be irritated by:

  • Getting frequent close-shave haircuts

  • Wearing a cap, durag, hard hat, head covering, or helmet

  • Wearing jewelry around your neck

  • Wearing a shirt with a collar

  • Being obese, which leads to having more tissue and skin folds on the back of the neck and scalp that rub against each other

Dermatologists have also found that the following may increase the risk of developing AKN:

  • Having a chronic (long-term), mild infection

  • Taking one of these medications: Cyclosporine or certain medications used to treat epilepsy like carbamazepine or phenytoin

  • Having one or more close, blood relatives who have AKN

Who gets acne keloidalis nuchae?

Men of African ancestry have the greatest risk of developing this condition. Hispanic and Asian men who have darker skin tones and coarse, curly hair also develop AKN.

AKN is less common in women who have darker skin tones. This condition rarely develops in people who are white.

When does acne keloidalis nuchae begin?

AKN usually begins between 14 and 25 years of age. It’s rare for the condition to develop before puberty or after 50 years of age. Because AKN develops mostly in young men, this suggests that male hormones play a role in causing this condition. More research is needed to know what role these hormones play.

While studying AKN, dermatologists have learned that treatment can prevent this condition from worsening. The earlier you get diagnosed and treated, the better.

To find out what’s involved in getting diagnosed and treated, go to: Acne keloidalis nuchae: Diagnosis and treatment.

Getty Images

Brahe, C., Peters, K. et al. (2022). “Acne keloidalis nuchae in the armed forces.” Cutis. 2020 May;105(05):223-6.

Kelly AP, Bayat A. “Acne keloidalis nuchae.” In: Taylor and Kelly’s Dermatology for Skin of Color (2nd ed.), McGraw Hill, USA, 2016:224-9.

Ogunbiyi, A, “Acne keloidalis nuchae: prevalence, impact, and management challenges.” Clin Cosmet Investig Dermatol. 2016; 9: 483–489.

Satter EK, “Acne keloidalis nuchae.” Medscape. Last updated 11/13/2020. Last accessed 6/28/2022.

Written by:
Paula Ludmann, MS

Reviewed by:
Amanda Friedrichs, MD, FAAD
Chesahna Kindred, MD, MBA, FAAD
Omolara Olowoyeye, MD, FAAD

Last updated: 7/28/22