Acne keloidalis nuchae

Acne keloidalis nuchae (AKN), also known as folliculitis keloidalis or folliculitis keloidalis nuchae, is a chronic skin condition characterized by inflamed bumps and scars on the back of the neck. It primarily affects men of African descent but can occur in individuals of any ethnicity. The condition is not a form of acne, despite its name, but rather a type of folliculitis (inflammation of the hair follicle) and keloid formation.

Causes and Risk Factors

The exact cause of AKN is not fully understood, but it is believed to involve a combination of genetic predisposition, hair grooming practices (such as close shaving or use of razor blades that cause irritation and ingrown hairs), and possibly bacterial infections. Chronic irritation and inflammation can lead to the development of keloid scars.

Symptoms

AKN begins as small, itchy bumps on the back of the neck. These can become inflamed and may merge to form larger, keloid-like scars. The affected area can become tender, and in severe cases, the condition can lead to significant scarring and discomfort.

Diagnosis

Diagnosis of AKN is primarily clinical, based on the appearance of the skin and the patient's history. In some cases, a biopsy may be performed to rule out other conditions.

Treatment

Treatment options for AKN aim to reduce inflammation, prevent new lesions from forming, and improve cosmetic appearance. These may include:

• Antibiotics to treat any underlying infection
• Corticosteroids to reduce inflammation
• Laser therapy for hair removal and to reduce the size of keloids
• Surgery to remove large keloids, though this is generally considered a last resort due to the risk of further keloid formation

Preventive measures, such as avoiding close shaving and using electric clippers to keep hair short without causing irritation, are also recommended.

Prognosis

While AKN can be managed with treatment, it is a chronic condition that may require ongoing care to prevent flare-ups. Early intervention can help minimize scarring and improve outcomes.

Epidemiology

AKN is most common in men of African descent, typically presenting in young adulthood. However, it can affect individuals of any ethnicity and, rarely, women.