Acne Keloidalis Nuchae

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Overview

Acne keloidalis nuchae is a skin condition in which the back of the neck develops inflamed bumps. These bumps can grow larger as the condition progresses and can become painful; without treatment these bumps can result in large scars known as keloids. Acne keloidalis nuchae is seen almost exclusively in black men. The condition may be related to irritation from shaving, skin infection, or a problem with the immune system.

Who's at risk?

Acne keloidalis nuchae is most commonly found in young adult men of African descent, and it is less commonly seen in men of Latino or Asian descent. It is very uncommon in women.

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. (But no hard scrubbing!)
  • Avoid head wear (such as sports helmets) and shirt collars that rub against the back of your neck.
  • Avoid closely shaving 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:
  • Steroid injections directly into the inflamed bumps or scars
  • Surgical excision of single bumps or larger scars
  • Laser destruction
  • Liquid nitrogen (freezing or cryotherapy)

Trusted Links

Clinical Information and Differential Diagnosis of Acne Keloidalis Nuchae

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.