Acne Keloidalis Nuchae

Acne Keloidalis Nuchae

Article
Men's Health
Skin Care
+1
Contributed byLester Fahrner, MD+1 moreOct 14, 2023

What are the other Names for this Condition? (Also known as/Synonyms)

  • Acne Cheloidalis Nuchae
  • Dermatitis Papillaris Capillitii
  • Sycosis Framboesiformis

What is Acne Keloidalis Nuchae? (Definition/ Background Information)

  • Acne Keloidalis Nuchae (AKN) is a benign skin condition that is characterized by the presence of papules and pustules in the head and neck region, which resemble keloid scars
  • AKN is mostly observed in dark-skinned individuals (such as African Americans), and predominantly in boys and young men. The skin lesions are often present with intense itching and can be painful
  • The cause of development of Acne Keloidalis Nuchae is presently unknown. It may result from chronic inflammation of the hair follicles on skin. The condition cannot spread from one individual to another
  • Also, no definitive risk factors are evident. Some research studies seem to indicate that constant friction and pressure of an external material (such as tight-fitting clothing), obesity, and the use of certain medications may result in Acne Keloidalis Nuchae
  • A diagnosis of Acne Keloidalis Nuchae is made by studying the presenting symptoms and skin biopsy (microscopic examination of the skin lesions). Following its diagnosis, the condition may be treated using topical creams and gels, oral medications, and laser ablation therapy
  • The prognosis of Acne Keloidalis Nuchae depends upon the severity of symptoms, the extent of the skin lesions, and one’s response to treatment. In many cases, with early recognition of the condition and appropriate treatment the prognosis is good.

Acne Keloidalis Nuchae is predominantly an inflammatory process of terminal hair follicles, it may not be considered by some as belonging to the Acne family of skin conditions. As the established name of AKN suggests, it is acneiform, and the uncertain contribution of the sebaceous component to pilosebaceous inflammation, it is included in the Acne category pending further study.

Who gets Acne Keloidalis Nuchae? (Age and Sex Distribution)

  • Acne Keloidalis Nuchae (AKN) is mainly observed in the age group 10-25 years. It is uncommon in older adults
  • The condition affects both males and females, though a vast majority of the cases are seen in males (male-female ratio is 20:1)
  • All racial and ethnic groups may be affected, but AKN is more common in dark-skinned people than light-skinned people. Thus, many cases are observed in young African-Americans
  • It is less commonly noted in Hispanics and Asians and very rarely in Caucasians

What are the Risk Factors for Acne Keloidalis Nuchae? (Predisposing Factors)

The risk factors for Acne Keloidalis Nuchae (AKN) are not well-defined, although, some researchers believe that the following factors may be responsible for AKN:

  • Shaving too close to the skin
  • Any material or article that is in constant touch or friction with the skin for prolonged periods such as:
    • Individuals wearing tight-fitting clothing including high collars
    • Athletes using sporting gear (helmets, shoulder pads, abdomen guard, etc.)
    • Military personnel, who carry heavy uniforms and backpacks
  • Obesity
  • Metabolic syndrome
  • Use of certain medications such as cyclosporine, diphenylhydantoin, and carbamazepine
  • Chronic inflammation due to certain autoimmune conditions
  • It is estimated that 0.5% of all African-Americans with a dermatological condition (or dermatosis) have AKN
  • Some researchers also believe that higher levels of testosterone during puberty may be a risk factor
  • Rarely, AKN has been associated with an uncommon X-linked disorder called keratosis follicularis spinulosa decalvans (KFSD)

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Acne Keloidalis Nuchae? (Etiology)

The exact cause of Acne Keloidalis Nuchae (AKN) development is not known.

  • The condition may be caused by chronic inflammation of the hair follicles (chronic folliculitis); this chronic inflammation may be the result of an abnormal immune system
  • Despite the name seeming to suggest a link to acne, Acne Keloidalis Nuchae does not occur due to acne vulgaris
  • A prior consideration of the cause was Pseudofolliculitis Barbae, with hair shafts trapped under the dermis causing inflammation

AKN is not contagious, and it cannot be transmitted from one individual to another.

What are the Signs and Symptoms of Acne Keloidalis Nuchae?

The signs and symptoms of Acne Keloidalis Nuchae (AKN) may be mild or severe and can vary in presentation from one individual to another. The signs and symptoms may include:

  • Presence of papules and pustules on the body - a resemblance to keloid scars is observed
  • The papules and pustules are generally itchy, which can result in continuous scratching
  • The papules are usually 5mm in size, but the range of affected area can vary from a few cm to grow to a large plaque over 10 cm in size
  • The skin lesions can be painful and may present themselves as localized patches or can be widespread in the neck region
  • AKN occurs in hair-bearing areas - most skin lesions are seen on the head and neck region (especially in the occipital scalp) and the back of the neck

How is Acne Keloidalis Nuchae Diagnosed?

The diagnosis of Acne Keloidalis Nuchae may involve:

  • A complete evaluation of medical history along with a thorough examination of the skin lesions
  • Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
  • Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
  • Complete blood count (CBC) test
  • Skin biopsy: A skin biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed), and with microscope findings, the pathologist arrives at a definitive diagnosis
  • Differential diagnosis of the following skin conditions presenting similar symptoms should be ruled out:
    • Acne vulgaris
    • Acne conglobata
    • Hidradenitis suppurativa

Note:

  • A skin biopsy may reveal acute inflammation around the hair follicles
  • Unlike, as suggested by the name of the condition (i.e., Acne Keloidalis Nuchae), there is no keloidal scar observed in AKN. It is a misnomer

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Acne Keloidalis Nuchae?

Complications associated with Acne Keloidalis Nuchae include:

  • Intense itching and severely painful lesions can cause psychological stress
  • Skin disfigurement due to the presence of widespread lesions. This can lead to cosmetic concerns and increased emotional stress
  • Scratching may result in secondary infections (superimposed bacterial and viral infection), which can also arise due to abscess formation
  • AKN can result in permanent hair loss in the affected region (or alopecia)
  • Decreased or increased skin color (hypopigmentation or hyperpigmentation respectively) following healing of the condition

The condition can last for many years causing additional emotional stress in the affected individuals.

How is Acne Keloidalis Nuchae Treated?

The treatment for Acne Keloidalis Nuchae (AKN) may include the following measures:

  • Removing the source of constant friction or pressure; avoiding the risk factors
  • Using antiseptic, antibiotic topical applications, anti-inflammatory gels, lotions, and creams. This may include the use of solutions containing:
    • Benzoyl peroxide
    • Salicylic acid
  • Use of tar shampoo
  • Topical retinoid and corticosteroid creams
  • Intra-lesional (injectable) corticosteroids; occasionally, oral corticosteroid therapy
  • Oral doxycycline administration
  • Injections of triamcinolone into the skin lesions
  • Phototherapy with ultraviolet light
  • Cryotherapy, when very low temperatures are used to treat the skin lesions
  • If the lesions are localized, then a complete surgical excision may be helpful in some cases of AKN
  • Antibacterial and antiviral medicines for any superimposed bacterial or viral infections, respectively

If the condition is severe and challenging to treat, or it fails to respond to the above treatment measures, then the following may be considered:

  • Radiation therapy
  • Topical 5-fluorouracil medication therapy
  • Surgical laser ablation may be employed
  • Regular follow-up visits with the healthcare providers are important

The following tips are helpful and may be noted for Acne Keloidalis Nuchae:

  • If any of the prescribed treatments causes new stinging or burning symptoms, then it is important to stop using them immediately and inform the physician’s office
  • Taking care of oneself, being clean and hygienic (especially face and hands), avoiding the urge to touch/break the blisters, avoiding oily make-ups and creams, drinking lots of water, etc. are all simple practices that can ensure a faster recovery from the condition
  • Avoid excessive washing and scrubbing of the skin
  • Do not pop or lance the affected skin; this merely spreads bacteria and leads to excessive scarring
  • Completely avoid scratching the affected areas

How can Acne Keloidalis Nuchae be Prevented?

Currently, there are no specific methods or guidelines to prevent Acne Keloidalis Nuchae. However, the following may be considered:

  • Decrease or eliminate the usage of clothing/equipment that causes constant skin irritation due to friction (skin contact)
  • Avoid close shaving; a clipper to cut hair is preferred
  • Stay physically fit and active through a well-balanced diet and exercising
  • Preventing the formation of severe signs and symptoms through early recognition and suitable treatment
  • Regular medical screening at periodic intervals with physical checkups and blood tests is important

What is the Prognosis of Acne Keloidalis Nuchae? (Outcomes/Resolutions)

  • The prognosis of Acne Keloidalis Nuchae depends on the extent and severity of the signs and symptoms. Nevertheless, in general, the prognosis is usually good, if the skin condition is diagnosed promptly and treated appropriately
  • Individuals with milder signs and symptoms (having focal skin lesions) have a better prognosis than those with severe signs and symptoms (and widespread lesions)
  • The condition is more difficult to treat if there is permanent disfigurement of skin. Also, without proper treatment, the condition may last for several years

Additional and Relevant Useful Information for Acne Keloidalis Nuchae:

  • There is no evidence to prove that oily foods and chocolate-based products influence Acne Keloidalis Nuchae (AKN)
  • Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken to avoid strong soaps and chemicals that could potentially worsen the condition
  • The presence of dirt on the body is not a causative factor for AKN. However, it helps to be clean and hygienic, which will help prevent the condition from getting worse
  • Keloid scars are benign proliferation of scar tissue that does not remain confined to the region of injury but goes beyond it

The following link will help you understand keloid scars:

http://www.dovemed.com/diseases-conditions/keloid-scar/

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On the Article

Krish Tangella MD, MBA picture
Approved by

Krish Tangella MD, MBA

Pathology, Medical Editorial Board, DoveMed Team
Lester Fahrner, MD picture
Reviewed by

Lester Fahrner, MD

Chief Medical Officer, DoveMed Team

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