Acne keloidalis nuchae: Diagnosis and treatment
An accurate diagnosis and proper treatment can prevent acne keloidalis nuchae from worsening and becoming more difficult to treat
Board-certified dermatologists have the most experience diagnosing and treating this condition.
How do dermatologists diagnose acne keloidalis nuchae?
Your dermatologist diagnoses acne keloidalis nuchae (AKN) by looking for signs of the condition, primarily on the back of your scalp and neck. During this exam, your dermatologist is looking for the following signs:
Hair loss due to scarring
Your dermatologist will also ask you questions, including how often you get your hair cut and whether you frequently wear a helmet or other headwear.
If it looks like you have an infection, your dermatologist will swab a pus-filled bump or other area on your skin that might be infected. This swab will be sent to the lab, where they can run testing to find out what’s causing the signs of infection.
Once your dermatologist has all the information needed, they will tell you what’s causing the skin condition.
If you have AKN, your dermatologist will recommend that you start treatment immediately. This helps prevent AKN from worsening.
When treatment starts early before scarring develops, most patients have a good outcome from treatment. Once scarring develops, AKN becomes harder to treat.
How do dermatologists treat acne keloidalis nuchae?
When creating a treatment plan, your dermatologist considers what signs of AKN you have on your skin. Your dermatologist will also think about whether you’re in pain or have an infection, and how AKN is affecting your life. Using this information, your dermatologist will customize a treatment plan for you.
Your treatment plan may include one or more of the following:
Patient education to help you stop irritating the skin with AKN: Usually the first step in treating AKN is to figure out what’s irritating your skin. Getting haircuts that require a close shave, wearing a helmet or shirts with collars, and scratching can all irritate the area. Your dermatologist will work with you to find out what you’re doing that could be irritating the area so that you can stop. When the irritation stops, this helps to stop AKN from worsening.
An antimicrobial cleanser and shampoo or tar shampoo: Skin with AKN has a greater risk of getting infected than skin without AKN. Using a product like a gentle, foaming benzoyl peroxide wash (an antimicrobial cleanser) helps to prevent infection.
A medicated product to soften coarse hairs: You apply this product to the area with AKN. It usually contains alpha-hydroxy acid or a retinoid.
Treatment to reduce the number, size, and firmness of the bumps: Dermatologists often prescribe a corticosteroid that you apply to your skin. This may be used along with a retinoid that you also apply to the skin. Some patients receive injections of corticosteroids.
Antibiotic to treat an infection: You may need an antibiotic that you apply to the area with AKN or antibiotic pills.
Surgery to remove raised, keloid-like scarring: If you have a keloid-like scar, your dermatologist may recommend a treatment called surgical excision. During this treatment, a dermatologic surgeon cuts out the scar and replaces the removed tissue with healthy skin from elsewhere on your body. When the keloid-like scar is completely removed, it cannot grow back.
Treatment to drain painful, swollen lumps: If you’ve had AKN for some time, you may have developed an abscess (a swollen, painful area containing pus) or tunneling in your skin called a sinus tract. These develop when you have a serious infection. Your dermatologist may drain these and prescribe medication to treat the infection.
Acne keloidalis nuchae can be difficult to treat
Sometimes, the above treatments fail to relieve the signs and symptoms of AKN. Your dermatologist can try other treatments like laser therapy, phototherapy, or laser hair removal to help reduce the bumps or keloid-like growths. Some patients have had success with one of these treatments.
If you have advanced AKN, scarring can cover a large portion of your scalp, neck, or both. You may have severe pain, swelling, pus leaking from the area, and bleeding.
The treatments described above may fail to treat advanced AKN. If this happens, your dermatologist may recommend an unconventional treatment like low-dose radiation therapy. The radiation kills the hairs in the area. When this happens, the keloid-like growths may shrink and eventually go away.
Due to possible long-term side effects, radiation therapy is considered only when other treatments fail.
Maintenance therapy helps keep the condition stable
After you finish treatment, your dermatologist may recommend maintenance therapy. This can keep AKN from worsening and maintain the results from treatment.
Most patients can keep AKN stable when they:
Wash the back of their neck and scalp with a gentle cleanser that contains benzoyl peroxide
Apply medication to the areas treated for AKN.
Self-care also plays an important role
Along with treatment, your dermatologist will talk with you about self-care, which can help prevent AKN from worsening and improve results from treatment. You’ll see what dermatologists recommend at: Acne keloidalis nuchae: Self-care.
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Paula Ludmann, MS
Amanda Friedrichs, MD, FAAD
Chesahna Kindred, MD, MBA, FAAD
Omolara Olowoyeye, MD, FAAD
Last updated: 7/28/22