Acne Keloidalis Nuchae
Acne Keloidalis Nuchae, or hair bumps, is a condition that arises at the juncture of the scalp and the back of the neck (nape). Often seen in African American men, this problem can arise when hair, at the nape of the neck is cut or shaved quite short, typically less than 1/4 inch in length. In curly haired individuals, the hair is able to corkscrew back into the hair follicle where it causes irritation, much like an acne lesion. In the occasional unfortunate person prone to developing keloids, (firm raised scar tissue), this inflamed bump turns into a permanent ball of scar tissue. In severe cases, hair can be permanently lost in areas of widespread inflammation.
Acne Keloidalis Nuchae
Description: Firm, flesh dark-colored papules and pustules that can proliferate and coalesce into large keloidal nodules and plaques.
Etiology: Unknown. Probable genetic predisposition. Exacerbated by manipulation.
Location: Primarly located on the posterior neck and occipital scalp. Commonly affects African-American men, but has (rarely) been reported in women and in non African Americans.
Causes
Acne keloidalis nuchae is most common on the male face, but it can also happen on other parts of the body where hair is shaved or plucked, especially areas where hair is curly and the skin is sensitive, such as genital shaving.
After a hair has been shaved, it begins to grow back. Curly hair tends to curl into the skin instead of straight out the follicle. PFB can make the skin look itchy and red, and in some cases, it can even look like pimples. These inflamed papules or pustules can form especially if the area becomes infected.
Epidemiology
Acne keloidalis nuchae is most common in black men. It can be seen in white patients, though this is far less common. And, although less frequent in women, acne keloidalis has also been observed in this patient population.4 Acne keloidalis has been reported to represent 0.45% of all dermatoses in black patients.5 More recent studies report a higher frequency in black patients presenting to dermatology clinics, ranging from 1.3% in a Nigerian study to 13.7% in a British study.6,7
Treatment of AKN includes suppression of the inflammation with antibiotics and steroid gels or intralesional steroid injections. Larger bumps of AKN present for a while or if not responding to treatments may need surgical removal. Unfortunately, to prevent regrowth they need to be cut out widely and deeply. They heal best if left open, which can take weeks to months. Intralesional steroid injections or radiation treatment after surgery helps prevent recurrence of the AKN.
The best way to prevent AKN is to simply avoid shaving. It this can’t be done at least follow some pre-shaving regimen. You can soften your hair by using a washcloth drenched in hot water for five minutes. Preshave solution can also help the skin prepare for shaving. You can also opt to purchase lubricating shaving gel or oil. If you have a severe case of AKN, head on to your dermatologist and he can prescribe a medicated shaving solution.
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