Acne Keloidalis Nuchae (AKN) -causes, features and treatment

At RPM Health Clinic, we understand Acne Keloidalis Nuchae—a chronic skin condition that primarily affects the back of the neck and scalp. Our focus is on long-term management and prevention to help you achieve healthier, smoother skin, free from discomfort and scarring.

If you’re looking for an effective, solution to Acne Keloidalis Nuchae, RPM Health Clinic is here to help. Book your consultation today and take the first step toward clear, healthier skin.

What is Acne Keloidalis Nuchae (AKN)?

Acne Keloidalis Nuchae (AKN) is a challenging dermatological condition predominantly affecting the back of the scalp and neck. Known for its tendency to cause discomfort, scarring, and visible keloid-like bumps, AKN can greatly affect quality of life.

AKN is a chronic inflammatory skin condition characterized by firm papules, pustules, and plaque formations at the nape of the neck and, in more severe cases, onto the scalp. This condition primarily affects men with coarse, curly hair and is more commonly observed in individuals of African, Hispanic, or Asian descent. It is considered to be a type of folliculitis that can progress into keloid-like formations when untreated.

Risk Factors for Developing Acne Keloidalis Nuchae (AKN) 

  • Family history: A genetic predisposition can increase the likelihood of developing AKN. 
  • Male sex: Men are 20 times more likely to develop AKN compared to women. 
  • Young age: The condition most often begins in adolescence or early adulthood. 
  • Dark skin and curly hair: Individuals with darker skin tones and curly hair are more prone to AKN. 
  • Hormonal influences: Elevated testosterone levels can contribute to the condition’s development. 
  • Frequent scalp irritation: Practices like close shaving or frequent haircuts can lead to repeated injury to the scalp, increasing the risk of AKN. 

Causes of Acne Keloidalis Nuchae

Although the exact cause remains unknown, several factors contribute to the development of AKN:

  • Hair Texture and Growth Patterns: Coarse or curly hair that curls back into the skin is more prone to becoming trapped in hair follicles, which can lead to inflammation and infection.
  • Mechanical Irritation: Frequent shaving, tight-fitting clothing, or headgear can cause irritation and micro-injuries, increasing the risk of AKN.
  • Inflammatory Responses: For some individuals, the immune system may react strongly to minor skin trauma, leading to inflammation and the formation of keloid-like scars.
  • Secondary Infections: Once inflammation occurs, bacteria can easily enter through small tears in the skin, exacerbating the condition and causing pustules or abscesses.

Clinical Features of Acne Keloidalis Nuchae

Identifying AKN early on allows for more effective intervention. Here are the primary clinical characteristics of AKN:

  • Location: Typically localized on the back of the neck, near the hairline, but can extend to the scalp if untreated.
  • Initial Appearance: Starts as small, firm, skin-colored to pink papules, which are often tender to the touch and may itch.
  • Progression: These papules can evolve into larger keloid-like plaques that are difficult to treat and may leave scarring if unmanaged.
  • Advanced Symptoms: In more severe cases, pustules or abscesses form, resulting in painful, purulent lesions that may rupture and scar.
  • Associated Hair Loss: Scarring and fibrosis around hair follicles can lead to permanent alopecia in the affected area.

How to prevent or reduce risks of developing Acne Keloidalis Nuchae

– Avoid irritation from closely fitting caps/collars/helmets, clothing
– Refrain from aggressive hair grooming practices (e.g. short haircuts/ close shaves)
– Practice good topical hygiene with antimicrobial (chlorhexidine or benzoyl peroxide based) cleansers/shampoos.

Our Approach to Treating Acne Keloidalis Nuchae at RPM Health Clinic

RPM Health Clinic takes a comprehensive and individualized approach to AKN treatment, focusing on both symptom relief and long-term skin health. Our range of treatments includes:

1. Medical Management

  • Topical Antibiotics: To combat bacterial overgrowth, topical antibiotics such as clindamycin or erythromycin can help prevent secondary infections in active lesions.
  • Topical Retinoids and Keratolytics: Retinoids and keratolytics (e.g., salicylic acid) can help exfoliate and reduce hyperkeratosis, promoting smoother skin texture and reducing follicular plugging.
  • Oral Medications: In cases of extensive inflammation, systemic antibiotics like doxycycline or anti-inflammatory agents may be prescribed to reduce infection and calm inflammatory responses.

2. Intralesional Corticosteroid Injections

  • Purpose: Intralesional corticosteroid injections are effective for reducing the size of inflamed keloid-like lesions. These injections help flatten the plaques and relieve associated discomfort.
  • Treatment Plan: A tailored course of injections can be administered over several sessions, spaced weeks apart, to achieve optimal results and reduce the potential for recurrence.

3. Minor Surgical Management

  • Excision of Lesions: For patients with severe, extensive scarring or large lesions, minor surgical excision may be considered. The aim is to remove problematic areas while preserving as much healthy tissue as possible.
  • Surgical Excision of Sinus Tracts: In cases where recurrent infection has led to sinus tract formation, we can surgically remove these tracks to prevent future infections and alleviate discomfort.
  • Cryotherapy of Lesions: For smaller nodules and lesions , using liquid nitrogen – freezing them off- can be sufficient
  • Electrocautery : In cases of small and medial size of nodules , electrocautery can be use to remove excess tissue , presuming no sinus tracts are present
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