Acne keloidalis nuchae

Acne keloidalis nuchae (AKN) is an inflammatory skin condition that’s marked by bumps and scar tissue resembling keloids (a type of raised scar) on the back of the head and neck.

It most commonly affects young Black men, but it can also affect other people. While AKN can cause embarrassment, frustration and discomfort, there are a number of ways to help treat the condition.

AKN is a condition that causes inflammation and scarring of the hair follicles. It typically affects the back of the scalp and nape of the neck. Note that despite what its name implies, AKN is not a form of acne.

AKN begins with inflammation of the hair follicles, which causes bumps that typically occur in hair-bearing areas of the nape of the neck and back of the scalp. The bumps may:

• Be painful or itchy
• Look pink or red
• Appear infected, with crusting and a slight discharge; pustules, or bumps filled with pus, may also occur around the hair follicles

As these bumps heal, they form small, raised scars that look like keloids, which may, over time, enlarge to form keloidal plaques and scar-like masses. These scars are typically hairless and can form a band along the hairline and nape of the neck.

AKN occurs most often in Black men, but it can occur in other populations. It affects men more often than women, and it typically occurs after puberty and before the age of 50.

If you have signs of AKN, see your healthcare provider. Early treatment can help reduce the risk of scarring. There is no one treatment for AKN. Treatment depends on a range of factors, including the size and depth of the lesions and whether they’re infected. Your treatment may involve avoiding possible triggers, using medications or trying other treatments to decrease inflammation and reduce the appearance of scars.

Avoiding triggers

Some people believe that certain triggers worsen AKN. However, more research is needed to fully understand the link between possible exacerbating factors and AKN. Still, your healthcare provider may suggest that you:

• Do not pick, rub or scratch the affected areas of your skin
• Do not shave, trim or use a razor along the hairline on the back of your neck
• Do not wear tight hats, helmets or shirts with a collar

Medications and other treatments

Your healthcare provider may recommend medications to help ease inflammation. If you have mild to moderate inflammation, it may respond to topical medications. Your provider may prescribe medications, such as topical corticosteroids, antibacterials or retinoids. If the inflammation is moderate to severe, your provider may also prescribe oral medications. People with AKN sometimes develop secondary infections. If this happens, your healthcare provider will likely give you an antibiotic to treat the infection.

You may also receive corticosteroid injections into the affected areas of your skin. These injections may help reduce inflammation that doesn’t respond to other medications. They may also help decrease scarring. If you have large or persistent lesions, your provider may recommend removing the affected skin with surgery or laser therapy.

AKN can be a very frustrating skin condition, but with the right treatment, you may be able to decrease inflammation and scarring. The sooner this condition is treated, the less disfiguring it may be. Work with your healthcare provider for guidance on how to best treat and manage AKN.

Published October 2021.