Treatment Solutions for Acne Keloidalis Nuchae: AKN Treatment Options

Acne keloidalis nuchae (AKN) is a severe type of folliculitis that affects hair follicles and coincides with chronic inflammation. AKN is also known as keloidal folliculitis or nuchal keloidal acne. Since it appears as bumps that grow and become problematic without treatment, it’s important to seek the help of a board certified dermatologist at the first warning signs. AKN treatment may be approached from numerous ways, dependent on how severe the case is and other medical factors.

AKN first appears as bumps wherever hair grows on skin, either as papules or pustules. Papules are similar to pimples, while pustules are filled with pus.


Symptoms of AKN typically start on the back of the head and upper portion of the neck with individual papules horizontally joining together. When solid lesions are greater than 1 centimeter in diameter and elevates, AKN reveals itself as plaques. The affected areas loose hair due to the plaques limited hair growth still surround the area. Ingrown hairs then result when aberrant hair shafts in areas affected by AKN break.

Without treatment, AKN advances and lesions grow. The area experiences pain, itching and pus discharge. AKN is a permanent, chronic condition that is difficult to treat. This is why it is so important to seek AKN treatment with a dermatologist as soon as possible to prevent further lesion growth.

In terms of the skin conditions affecting race, African-Americans experience it the most. They are followed by Asians and Hispanics/Latinos, plus it rarely occurs in Caucasians.


The most probable hypotheses for AKN include:

  • Autoimmune correlations (reverse hair growth, exaggerated healing)
  • Skin irritation (shaving, hair shaft breakage from clothing, etc.)
  • Bacterial infections
  • Cyclosporine
  • Mast cells
  • Cyclosporine (immune system suppressant drug)



AKN treatment options are both non-surgical and surgical procedures. The AKN treatment route is dependent on the severity and stage of the condition.

Surgical Options:

  • Excision using a primary closure technique
  • A combination of excision and grafting
  • Excision using a primary closure technique
  • Electrosurgical excision
  • Staged excision with primary closure
  • Excision with trychophytic closure
  • Excision with secondary intention healing

Nonsurgical Options:

  • A topical antibiotic
  • Isotretinoin
  • Radiation therapy
  • Triamcinolone acetonide
  • Specialized shampoos
  • Topical steroids
  • Cryotherapy
  • Isotretinoin
  • Excision with Trychophytic Closure


    AKN treatment before and after photos of a patient who had a surgical incision.

For advanced cases, combined surgical excisions and trichophytic closure combinations can improve AKN. Always consult with a physician or surgical dermatologist to determine the best plan for individual cases.

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