Treatment of Acne Keloidalis Nuchae: A Systematic Review of the Literature

Abstract

Acne keloidalis nuchae (AKN) is a chronic inflammatory condition that leads to fibrotic plaques, papules and alopecia on the occiput and/or nape of the neck. Traditional medical management focuses on prevention, utilization of oral and topical antibiotics, and intralesional steroids in order to decrease inflammation and secondary infections. Unfortunately, therapy may require months of treatment to achieve incomplete results and recurrences are common. Surgical approach to treatment of lesions is invasive, may require general anesthesia and requires more time to recover. Light and laser therapies offer an alternative treatment for AKN. The present study systematically reviews the currently available literature on the treatment of AKN. While all modalities are discussed, light and laser therapy is emphasized due to its relatively unknown role in clinical management of AKN. The most studied modalities in the literature were the 1064-nm neodymium-doped yttrium aluminum garnet laser, 810-nm diode laser, and CO2 laser, which allow for 82–95% improvement in 1–5 sessions. Moreover, side effects were minimal with transient erythema and mild burning being the most common. Overall, further larger-scale randomized head to head control trials are needed to determine optimal treatments.

Acne keloidalis nuchae: prevalence, impact, and management challenges

“…The 1064 nm Nd: YAG destroys the hair follicles within the lesions which has some bearing on the inflammation 38. It can be used in conjunction with topical steroids or retinoids and has been found useful in refractory cases.…”

Surgical Treatment of Scarring Alopecia Associated with Acne Keloidalis Nuchae

“…Pestalardo et al [8] reported total excision using a tissue expander. Both authors demonstrated excellent outcomes for the treatment of AKN-associated alopecia, but both maneuvers required multistage surgery [1] [6] [8]. Although long scars might re-…”

“…Acne keloidalis nuchae (AKN) is an idiopathic chronic inflammatory condition characterized by the formation of papules and pustules that ultimately develop into keloid-like masses on the occiput and nape of the neck [1] [2]. This hyperproliferative disorder typically occurs in young adult males of African origin [2] [3], but it is relatively rare in the Asian population [4].…”

“…The relapsing condition leads to sparse hair or multiple large keloids on the occipital scalp [1] [3]. Scarring alopecia that has resulted from long-lasting folli-culitis cannot be cured by conservative treatment, and impairs the psychosocial functioning and self-esteem of patients [3].…”

“…Scarring alopecia that has resulted from long-lasting folli-culitis cannot be cured by conservative treatment, and impairs the psychosocial functioning and self-esteem of patients [3]. Although many authors have reported the effectiveness of nonsurgical and surgical treatments, such treatments attempt to prevent the recurrence of this inflammatory condition; very few reports have focused on the treatment of the alopecia associated with AKN [1].…”