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Acne keloidalis nuchae: Signs and symptoms

Where does acne keloidalis nuchae appear on the body?

This condition typically develops on the:

  • Back of the neck

  • Back of the scalp

What are the signs and symptoms of acne keloidalis nuchae?

What you see (and feel) on your skin tends to change as the condition worsens. The following explains how AKN begins and can progress without treatment. You’ll also see a few pictures of AKN that show what this condition can look like as it progresses.


Before you develop bumps, the back of your neck or scalp may itch. The itch may develop hours or days after wearing a helmet or getting a close-shave haircut.

Black man reaching to scratch the back of his neck

Firm, dome-shaped bumps develop

A rash of small bumps appears on your neck, back of your head, or both. These often-itchy bumps can be mistaken for pimples or razor bumps. Scratching or combing where you have bumps can cause an infection, so you may also see pus-filled bumps.

Early acne keloidalis nuchae on back of scalp

More bumps appear

Without proper treatment, AKN can worsen. If this happens, existing bumps grow and new bumps appear. Growing bumps can be painful. Some bumps may bleed.

Large pimple-like bumps on back of scalp due to acne keloidalis nuchae

Bumps join together to form a scar

In time, the bumps become small scars that can grow together and create a large, raised scar. This raised scar can be painful, and often becomes more painful as it grows.

Scar on back of head due to acne keloidalis nuchae

Hair loss

Where scars develop, you’ll see hair loss. Most people develop a large, raised scar that spans their entire hairline. Scars can also appear in patches. Near the edge of the scars, ingrown hairs or tufted hairs can develop. Tufted hairs occur when several hairs grow out of one hair follicle (the opening in the skin from which a hair grows).

Hair loss due to acne keloidalis nuchae

Painful areas on your skin

Without medical care, AKN can continue to worsen. Some people develop swollen areas under their skin that contain pus. Called abscesses, these areas can grow together and form tunnels under the skin. The tunnels are called sinus tracts. Both abscesses and sinus tracts can leak a foul-smelling liquid onto the skin.

Pain on back of head due to acne keloidalis nuchae

Why some people develop AKN is still a bit unclear. Dermatologists have found that some people are more likely to develop it than others. To see if you have an increased risk, go to: Acne keloidalis nuchae: Causes.


  • Images 1, 6: Getty Images

  • Image 2: Image used with permission of the JAAD Case Reports. (JAAD Case Rep. 2019 Jun 8;5(6):529-34.)

  • Images 3,5: Images used with permission of DermNet NZ.

  • Image 4: Image used with permission of the JAAD Case Reports. (JAAD Case Rep. 2018 Dec 4;5(1):24-8.)

Brahe C, Peters K, et al. “Acne keloidalis nuchae in the armed forces.” Cutis. 2020 May;105(5):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 Dec 14;9:483-9.

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