Cather McKay, MD

Acne keloidalis nuchae (AKN) is a skin condition that starts with acne-like bumps around hair follicles on the back of the neck and lower scalp. The bumps may itch or hurt, and may or may not have pus. Over time firm scars similar to keloids form and hair loss may occur. 

AKN mainly affects black men but can occur in other ethnicities and rarely in women. The cause of AKN is not fully understood. Inflammation starts around hair follicles, leading to trapped hairs which cause more inflammation and scarring. AKN is often mistaken for razor bumps or an infection from the barber. AKN is not an infection and is not contagious. A board-certified dermatologist can make a diagnosis of AKN by examining the area.

What are the best “acne keloidalis nuchae” treatments? 

While we do not have a cure for AKN, there are hair care tips and treatment options that can help. The sooner a diagnosis is made, the earlier treatment can begin.  Early treatment is important to avoid more advanced scarring and hair loss.

• Avoid trimming hair too short on the back of the neck
• Avoid tight clothing, hats, durags, or helmets, that rub on the area
• Avoid picking, squeezing, or digging for trapped hairs

Medicated options include:

• Corticosteroids in topical solution/gel formulation
• Corticosteroids injected into the affected area by your doctor or other health care practitioner
• Benzoyl peroxide cleanser or gel
• Topical antibiotics such as clindamycin lotion or gel
• Oral antibiotics such as doxycycline or minocycline
• Topical retinoids such as tretinoin gel
• Oral retinoids such as isotretinoin
• Laser or traditional surgery to remove scar tissue