Acne keloidalis nuchae

A 20-year-old black man is presented for evaluation of a severe rash on his neck.

His family history is negative for a similar condition.

His condition was first noted approximately 2 years ago and has recently increased in severity. He complains of intermittent tightness, pain, and drainage associated with the rash.

Flocked and merged papules and pustules.

Plaques and keloidal scarring

Posterior site of the neck

None

Examination reveals multiple firm papules and plaques on his posterior scalp and neck.

The differential diagnosis includes folliculitis secondary to bacterial infection, especially Staphylococcus, which needs to be excluded. In bacterial folliculitis, the pustular or papular response is more widely distributed across the entire scalp and does not localize to the nape of the neck.

Acne keloidalis nuchae

1.Prevention Encourage those with AKN to avoid any causes of mechanical irritation to the posterior hairline: no plucking, pulling or close haircutting in the region, with recommended daily brushing of the area to lift hairs that may be regrowing into the surface of the skin. 2.Noninflamed papules-topical cortical steroid such as betamethasone diproprionate 0.05% 3.Inflamed papules-topical clindamycin, oral tetracycline 4.In order to reduce the bulk of scar tissue,it would be helpful to perform intralesional injection of triamcinolone