Zeitschrift für klinische und experimentelle Dermatologieforschung
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Acne Keloidalis Nuchae is Not the Same as a Keloid: A Case Report of Successful Excision with Healing by Secondary Intention

Cassandra A Ligh and Paris D Butler

Introduction: Acne keloidalis nuchae (AKN) is a chronic folliculitis along the nape of the neck and occipital scalp that results in scarring alopecia and disfiguring keloid-like plaques often associated with infection, pain, bleeding, malodor, and progression in size. AKN appears similar to keloids, yet there are differences in pathophysiology. These two cases highlight a surgical treatment course for AKN that plastic surgeons can incorporate into their practice.

Methods: Two case studies of 25-year-old African-American males with several year histories of keloid-like masses of the posterior scalp that had been medically managed as keloids and presented to clinic for second opinions. They underwent local wide excision of AKN masses that included the posterior hairline and at least 0.5-centimeters of healthy tissue margin, followed by secondary intention healing.

Results: Patients were followed post-operatively and had aesthetically acceptable outcomes with significant improvement, one with disease-free result and the other with evidence of new disease superior to his wound requiring repeat excision and radiation.

Conclusions: By completely excising the affected tissue, along with removal of the posterior hairline, patients can be disease-free and have an aesthetically acceptable outcome.