Acne Keloidalis Nuchae (AKN): Causes, Symptoms, and Treatment

image: AKN lesion on the posterior neck- source: RICHARD USATINE MD/SCIENCEPHOTO LIBRARY

INTRODUCTION TO AKN

Acne Keloidalis Nuchae (AKN), also known as folliculitis keloidalis, is a chronic inflammatory skin condition that primarily affects the nape of the neck and scalp. Although it is called acne, AKN is not a true acne but rather a form of scarring folliculitis that develops into keloid-like bumps, pustules, and fibrosis. It occurs predominantly in men of African descent aged 15 - 40 years. This condition is linked to haircutting practices, friction, and gene predisposition.

CAUSES AND RISK FACTORS

The exact cause of AKN remains unclear, but contributing factors include:

Trauma from shaving/close haircuts may cause irritated hair follicles.
Chronic irritation from collars of clothes, helmets, and/or tight clothing.
Bacterial infection like Staphylococcus aureus, often colonizes lesions.
Genetic susceptibility, which can be found in males of black descent.
Androgenic instances, like hormonal role in follicular inflammation.

SYMPTOMS AND DIAGNOSIS

AKN begins as a small, itchy papule and develops into pustules and abscesses resembling acne. It also develops into keloid-like scars, which resemble a firm and hypertrophic nodule. One can also start to notice hair loss due to destroyed follicles.

Diagnosis is usually and primarily clinical where a visual examination of the affected area would be conducted. In serious cases, a skin biopsy is performed to determine the extent of hair loss ot skin damage.

TREATMENT AND PREVENTION

Early-stage AKN may respond to:

Tropical steroid, which helps to reduce inflammation.
Oral antibiotics like tetracycline.

Advanced AKN often requires:

Laser therapy may help reduce hair follicles.
Intralesional steroid injection.
Surgical excision of the affected area, especially for large, refractory scars.

Preventive tips include:

Avoidance of close shaving, reduction of neck friction, and use of antiseptic cleaners after barbing or shaving.

Sources for Citing

National Center for Biotechnology Information. (2023). Acne Keloidalis Nuchae. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK459129/
American Academy of Dermatology. (2022). Acne Keloidalis Nuchae: Diagnosis and Treatment. https://www.aad.org/public/diseases/a-z/acne-keloidalis-treatment
DermNet NZ. (2021). Acne Keloidalis Nuchae. https://dermnetnz.org/topics/acne-keloidalis-nuchae

Assessed and Endorsed by the MedReport Medical Review Board