Acne keloidalis nuchae is a type of folliculitis, which is inflammation of a hair follicle. It affects the back of your head and the nape of your neck. The name can be misleading: Acne keloidalis nuchae is actually not a type of acne. Other names for it include folliculitis keloidalis, acne keloidalis, or acne cheloidalis nuchae.
Acne keloidalis nuchae begins with small, itchy bumps that form around the back of the neck, along the hairline. As time goes on, the tiny bumps become scars, and the hair in and around them falls off. The scars eventually enlarge and look like keloids. These are tough, raised scars.
Doctors aren’t sure about what causes acne keloidalis nuchae, but some people do seem more likely to develop it than others. Males with darker skin, notably males of African descent, have a higher risk. Men with stiff or curly hair are also more likely to develop it.
While the exact cause is unknown, researchers have a few theories about possible causes:
- Close shaving. Some believe that injuries from close shaving cause inflammation that destroys the hair follicle.
- Constant irritation. Regular irritation or friction caused by shirt collars and helmets may pull on the hairs and cause folliculitis and eventual scarring. Heat and humidity may make it worse.
- Certain medications. There’ve been cases of people developing acne keloidalis nuchae after taking cyclosporine. This medication is used to treat rheumatoid arthritis and psoriasis. The use of antiepileptic drugs has also been linked to the condition.
- Genetic mutations. A genetic mutation that increases someone’s chances of having weak hair follicle structure may play a role.
- Chronic infection. Chronic, low-grade infections may also play a role in the development of acne keloidalis nuchae.
Acne keloidalis nuchae can be hard to treat. Different techniques work better for some people than others.
Different types of laser therapy have been used to treat acne keloidalis nuchae. Mild cases of the condition can be treated effectively using laser hair removal. Laser and light therapy work by decreasing the inflammatory response and destroying the hair follicle.
Most people require a few laser sessions spread out over a few weeks. Your doctor will want to treat any infection before you begin laser therapy. They may also have you use topical steroids or retinoids in combination with laser therapy to achieve better results.
Your doctor may prescribe one or more medications to treat your acne keloidalis nuchae, including:
- topical steroids for small papules
- oral antibiotics for any infections
- a short course of oral corticosteroids for large, inflamed lesions
- steroid injections for large papules
If your condition is severe and your scars are large, your doctor may recommend surgery.
Your options for surgery depend on the severity of your condition and may include:
- Surgical punch. Also called a skin punch or punch biopsy, this procedure is performed by using a hollow, circular blade to puncture the skin and remove the lesion. The area is treated with an anti-inflammatory medication and stitched closed.
- Surgical excision. This is a traditional surgery where a scalpel is used to cut the lesion. This method is used to treat large lesions and prevent them from growing back. This type of surgical wound heals best when left open. It may take weeks to months to heal.
- Electrosurgery. Instead of using a scalpel to excise the lesion, electrosurgery uses a high-frequency electric current to cut through the tissue.
As part of your treatment, your doctor may recommend certain over-the-counter products to help prevent the acne keloidalis nuchae from getting worse.
Tar shampoo, sometimes called coal tar shampoo, belongs to a class of drugs called keratoplastics. These drugs are used to treat various itchy skin conditions. They cause the skin to shed dead skin cells and slows the growth of new skin cells. This can relieve scaling and itchiness.
Preventing infection is an important part of treating acne keloidalis nuchae. Try to keep the area clean by regularly using an antimicrobial cleanser on the affected area. Look for one that contains benzoyl peroxide, like this one. Your doctor may also recommend a cleanser that contains chlorhexidine, like this one. Follow you doctor’s instructions on how often to use it and for how long.
While it can be hard to completely get rid of acne keloidalis nuchae, following these tips can help keep it under control:
- Wear collarless shirts and jackets that don’t rub the nape of your neck or hairline.
- Avoid very short haircuts or close shaves that can damage your hair follicles.
- Stop using pomade, hair grease, or similar products. They can interfere with hair growth.
- Avoid wearing hats and helmets that cause friction along the back of your neck.
- Keep the back of your neck clean and dry. When cleansing your skin, be careful not to rub too hard. Doing so can make your skin more irritated.
Acne keloidalis nuchae may not have a known cure, but it can be treated by avoiding triggers and using a combination of treatments recommended by your doctor.
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