Acne Keloidalis Nuchae

Overview

What is acne keloidalis nuchae?

Acne keloidalis nuchae (AKN) is a type of folliculitis, which is inflammation of your hair follicles. The chronic disorder affects the follicles on the back of your neck and back of your scalp, the skin covering your head where hair grows.

AKN can cause progressively worsening skin problems in the area, which may lead to scarring and hair loss.

The condition is also called:

  • Acne keloidalis.
  • Dermatitis papillaris capillitia.
  • Folliculitis keloidalis.
  • Folliculitis keloidalis nuchae.
  • Folliculitis nuchae.
  • Keloidal folliculitis.
  • Sycosis framboesiformis.

Who might get folliculitis keloidalis?

Anyone can develop this type of folliculitis. But it’s much more common in men with curly hair. It usually starts after adolescence.

Symptoms and Causes

What causes acne keloidalis nuchae?

Scientists aren’t sure what causes AKN, but some believe it might be due to:

  • Skin injury from irritation (like a helmet or tight collar) or certain hair-cutting methods, like very close shaves.
  • Immune reactions in the cells of hair follicles.
  • Extra androgen hormones or sensitivity to androgen.

How does acne keloidalis nuchae start?

The condition usually begins with red, itchy bumps (papules) or patches of skin. The papules tend to get infected because of scratching, leading to pustules (pockets of pus, almost like pimples).

What are the later symptoms of acne keloidalis nuchae?

Over time, AKN progresses to inflamed, thickened and scarred areas of skin (fibrosis, hypertrophic scars and keloids). Episodes of inflammation can range from mild to severe.

Symptoms may include:

  • Crusty feeling on your skin.
  • Itchiness.
  • Pain.
  • Plaques (scaly patches).
  • Thickening and scarring of your skin and hair follicles.
  • Tufts of hair loss.

Diagnosis and Tests

How is acne keloidalis nuchae diagnosed?

There aren’t perfect tests to diagnose acne keloidalis nuchae. A healthcare provider can diagnose the condition based on a physical exam of the neck and scalp. The healthcare provider will also ask about:

  • Symptoms.
  • When they started.
  • Whether they’ve changed over time.
  • What seems to irritate your skin.
  • Treatments you’ve already tried.

If the diagnosis isn’t clear, your healthcare provider may recommend a biopsy. The test takes a small sample of your skin so an expert can look at the cells under a microscope to help diagnose and treat the condition.

If the skin lesions seem to be infected, then your healthcare provider might order a culture. That’s a test to determine the type of infection. A culture can help decide what treatment can clear the infection.

Management and Treatment

How do you get rid of acne keloidalis nuchae?

There isn’t a cure for the condition, so treatment usually involves medications to ease symptoms, such as:

  • Topical or oral antibiotics to treat or prevent bacterial infection.
  • Retinoids (which come from vitamin A) to improve symptoms.
  • Steroids (in creams, pills or injections) to help calm inflammation.

Are there any other acne keloidalis nuchae treatments?

If acne keloidalis nuchae becomes severe, your healthcare provider may suggest surgical excision and skin grafting. This involves cutting away damaged portions of skin and replacing them with healthy patches of skin from somewhere else on your body.

Researchers are testing other ways of treating the condition, including laser therapy, phototherapy, laser hair removal and radiotherapy (only for cases that are resistant to all other treatments).

Prevention

Can you prevent AKN?

Because scientists don’t yet understand what causes AKN, there aren’t any proven ways to prevent it. Certain measures, like avoiding irritation and close shaving, may reduce symptoms and help prevent AKN development.

Outlook / Prognosis

What’s the outlook for a person with acne keloidalis nuchae?

AKN is a chronic condition without a cure, so it often lasts a lifetime. The goal of treatment is to manage symptoms, prevent infection and slow the progression of AKN.

Living With

How do I take care of myself?

Certain strategies may help ease symptoms and prevent infections:

  • Apply diluted apple cider vinegar or tea tree oil to your skin to prevent infection (mix one part vinegar or tea tree oil with three parts water).
  • Avoid clothing, hats or haircuts that may irritate your skin.
  • Clean your skin with antimicrobial cleansers to prevent infection.
  • Rub aloe on your skin to soothe and cool it.

When should I seek medical attention for acne keloidalis nuchae?

You should talk to your healthcare provider anytime skin problems are bothering you or interfering with your life.

With AKN, your skin is at risk for infection. Seek medical attention if you have any signs, such as:

  • Fever.
  • Pus draining from the area.
  • Swelling or pain that worsens over several days.

A note from Cleveland Clinic

Acne keloidalis nuchae (AKN) is a type of folliculitis, or inflammation of your hair follicles. It causes lesions on the skin of your neck and back of your scalp. AKN can worsen over time, leading to scarring and hair loss. Although there isn’t a cure, your healthcare provider can help ease symptoms and prevent infection and progression.

Last reviewed by a Cleveland Clinic medical professional on 05/02/2022.

References

  • Al Aboud DM, Badri T. Acne Keloidalis Nuchae. (https://www.ncbi.nlm.nih.gov/books/NBK459135/) [Updated 2021 Aug 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Accessed 5/2/2022.
  • DermNet AZ. Folliculitis keloidalis. (https://dermnetnz.org/topics/folliculitis-keloidalis) Accessed 5/2/2022.
  • Maranda EL, Simmons BJ, Nguyen AH, et al. Treatment of acne keloidalis nuchae: a systematic review of the literature. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4972740/) Dermatol Ther (Heidelb). 2016;6(3):363-78. Accessed 5/2/2022.
  • Ogunbiyi A. Acne keloidalis nuchae: prevalence, impact, and management challenges. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5167527/) Clin Cosmet Investig Dermatol. 2016;9:483-489. Accessed 5/2/2022.

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