This image displays the back of the neck at the hairline that is affected by acne keloidalis nuchae.  This image displays fairly small lesions of acne keloidalis nuchae. Numerous smooth, scar-like, small, raised lesions at the back of the neck are typical of acne keloidalis nuchae. This image displays a person with a variant of acne keloidalis nuchae, displaying depressed scars rather than thick keloids.  The back of the scalp and neck is the typical location for acne keloidalis.  This image displays acne keloidalis that has been aggravated by rubbing and scratching. This image displays round, smooth bumps typical of acne keloidalis nuchae. This image displays smooth, firm lesions typical of acne keloidalis nuchae. The lesions of acne keloidalis nuchae can be focused in a limited area at the back of the neck or scalp, as displayed in this image.
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Acne Keloidalis Nuchae  Information for adults

Picture of Acne Keloidalis Nuchae: This image displays the back of the neck at the hairline that is affected by acne keloidalis nuchae.  Divider line
This image displays the back of the neck at the hairline that is affected by acne keloidalis nuchae.
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Overview
Acne keloidalis nuchae, also known as keloidal folliculitis or nuchal keloidal acne, is a chronic skin condition characterized by inflamed bumps and scars on the back of the neck.

Although it is not related to common acne (acne vulgaris), acne keloidalis nuchae initially appears as acne-like lesions of inflamed hair follicles (folliculitis) on the nape of the neck (nuchal area) and, without treatment, can result in large scars (keloids).
Who's At Risk
Acne keloidalis nuchae is most commonly found in young adult men of African or, less commonly, Latino or Asian descent. It is very uncommon in women. In addition, acne keloidalis nuchae is very rarely seen in people prior to puberty or after middle age.
Signs and Symptoms
The most common locations of acne keloidalis nuchae include:
  • Back of the neck (posterior neck)
  • Lower back of the scalp (occipital scalp)
Initially, lesions of acne keloidalis nuchae appear as red or pus-filled bumps, which may be tender or itchy. Over time, these inflamed bumps develop into small scars. Without treatment, the small scars can coalesce into large, thick scars, or keloids. Areas of widespread scarring may be associated with hair loss. Rarely, advanced acne keloidalis nuchae lesions can develop deep pockets of pus with connections to the surface of the skin, and a foul-smelling discharge may ooze from these sinus tracts.
Self-Care Guidelines
People who develop acne keloidalis nuchae should focus on avoiding irritation to the area in order to prevent the formation of additional lesions:
  • Wash the area gently with non-irritating cleansers (no hard scrubbing!).
  • Avoid head wear (such as sports helmets) and shirt collars that rub against the back of your neck.
  • Avoid closely shaving of the back of your neck.
  • For itchy lesions, try an over-the-counter cortisone cream.
Generally, persons with acne keloidalis nuchae should see their primary care doctor or a dermatologist for treatment in order to prevent progression of the condition.
When to Seek Medical Care
If you suspect you have acne keloidalis nuchae, you should seek help from your primary care provider or a dermatologist in order to prevent the possible formation of large scars and permanent hair loss to the involved areas.
Treatments Your Physician May Prescribe
The prognosis of acne keloidalis nuchae is good if treatment is started early.

Topical creams, lotions, or gels may include:
  • A retinoid cream such as tretinoin, tazarotene, or adapalene.
  • A prescription-strength steroid or cortisone preparation.
  • An antibiotic such as clindamycin.
Oral medications may include:
  • Antibiotic pills.
  • A short course of steroids, such as prednisone (for severe or advanced cases only).
Procedures to reduce inflammation and reduce or remove scar tissue include:
  • Steroid injections directly into the inflamed bumps or scars.
  • Surgical excision of single bumps or larger scars.
  • Laser destruction.
  • Liquid nitrogen (freezing or cryotherapy).

References

Bolognia, Jean L., ed. Dermatology, pp.562-564, 1041-1042. New York: Mosby, 2003.

Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed, pp. 648-650. New York: McGraw-Hill, 2003.
Last Updated: 22 Dec 2008