Managing Acne Keloidalis Nuchae in a 31-Year-Old Male — Village Dermatology, Katy & Houston, Texas
Patient Overview:
A 31-year-old male presented to Village Dermatology as a new patient for evaluation of skin lesions located on the posterior neck, posterior scalp, and hairline. The lesions were described as darkening, enlarging, and irregular in shape. They had been progressively worsening over several years, with more rapid change over the past month.
The patient denied prior treatment and sought a comprehensive dermatologic evaluation and management plan.
Clinical Examination
A focused skin examination was performed, including the scalp, posterior neck, face, and ears. The patient appeared well-developed and well-nourished, and was alert and oriented. A dermatoscope was used to closely inspect the lesions.
Findings revealed follicular-based papules and pustules coalescing into keloid-like plaques distributed along the mid-occipital scalp and posterior neck — findings consistent with Acne Keloidalis Nuchae (AKN), a chronic inflammatory scarring condition.
Diagnosis: Acne Keloidalis Nuchae (AKN)
Acne Keloidalis Nuchae is a chronic inflammatory disorder of the hair follicles, most commonly affecting men with curly or coarse hair. It typically presents as persistent papules, pustules, and firm scars on the back of the scalp and neck. AKN may worsen with shaving, tight collars, helmets, or other forms of mechanical irritation.
If left untreated, it can lead to permanent scarring alopecia and cosmetic disfigurement.
Treatment Plan
At Village Dermatology, the patient’s management plan focused on both inflammation control and prevention of further scarring.
1. Oral Doxycycline (100 mg, twice daily for 6 weeks):
To reduce inflammation and control bacterial colonization. The patient was counseled on potential side effects including gastrointestinal upset and sun sensitivity.
2. Topical Clindamycin 1% Solution (twice daily):
To reduce surface bacterial activity and inflammation in the affected areas.
3. Benzoyl Peroxide Wash:
Recommended as an adjunctive antibacterial wash to lower follicular bacterial load.
4. Safe Grooming Practices:
The patient was advised to avoid close shaving, tight clothing, or friction against the affected area.
If improvement is limited, intralesional Kenalog (ILK) injections will be considered at follow-up visits to further flatten hypertrophic lesions and decrease inflammation.
Patient Counseling
The patient was counseled that Acne Keloidalis Nuchae is a chronic and progressive condition, often requiring long-term maintenance to prevent recurrence. Regular dermatology follow-ups in our Katy and Houston, Texas offices were recommended to monitor progress and adjust therapy as needed.
Takeaway
This case underscores the importance of early diagnosis and intervention in Acne Keloidalis Nuchae to prevent scarring and improve quality of life. Through a combination of oral antibiotics, topical treatments, and lifestyle modifications, significant improvement can be achieved.
At Village Dermatology, our board-certified dermatologists in Katy, Texas and Houston, Texas specialize in treating complex scalp and skin conditions like Acne Keloidalis Nuchae with compassionate, evidence-based care.
If You’re Experiencing Similar Symptoms
If you notice bumps, scarring, or irritation on the back of your scalp or neck, it’s important to seek evaluation before permanent scarring develops.
Contact Village Dermatology today to schedule your appointment at our convenient Katy or Houston locations.
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