Acne Keloidalis

The Surgical Management of Extensive Cases of Acne Keloidalis Nuchae

“…Acne keloidalis nuchae is not a keloid and has no relationship to acne vulgaris. [5][6][7] Some investigators have proposed that irritation and subsequent inflammation occur as a result of hairs recurving into the skin. 8 Others, however, have found no clinical or histologic evidence of hair shafts curving into the skin, as occurs in cases of pseudofolliculitis barbae.…”

“…8 Others, however, have found no clinical or histologic evidence of hair shafts curving into the skin, as occurs in cases of pseudofolliculitis barbae. 5,9 Close shaving of the neck in conjunction with the curved, coarse type of hair that is typically present in black patients has been proposed as an etiologic factor. 10,11 Constant rubbing of the neck and posterior region of the scalp by collars may also exacerbate AKN.…”

“…8,[11][12][13] The late lesions of AKN, with draining sinuses and large, keloidal masses, are often refractory to treatment, including therapy with topical and intralesional steroids, 5,8,12 topical and oral antibiotics, retinoids, 10,16 and irradiation. 5,6,10,14,17 Surgical approaches to late-stage AKN include epilation, 5,8,12,14 excision with second-intention healing, 10,13,16 excision with primary closure, 5,14,16,18 and excision with grafting. 5,12,14,16,17,19 The purpose of this study was to determine the efficacy of excision with primary closure in the treatment of 25 patients with extensive and refractory AKN.…”

“…5,6,10,14,17 Surgical approaches to late-stage AKN include epilation, 5,8,12,14 excision with second-intention healing, 10,13,16 excision with primary closure, 5,14,16,18 and excision with grafting. 5,12,14,16,17,19 The purpose of this study was to determine the efficacy of excision with primary closure in the treatment of 25 patients with extensive and refractory AKN.…”

“…13 Excision with subsequent split-thickness skin grafting has also been described in the treatment of AKN. 5,12,14,16,17,19 Unfortunately, the cosmetic benefits of skin grafting are limited. 15,16,18 Split-thickness skin grafts are often atrophic, smooth, and shiny, and do not match surrounding skin in color, texture, or thickness.…”