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Image of a cactus representing Acne keloidalis nuchae

Acne keloidalis nuchae - causes, symptoms and how you might treat it

Patches of hard, itchy, red bumps on the neck and the back of the head might look like acne, but they may be a condition known as acne keloidalis nuchae.

These lumps can form into enlarged, raised – or keloid – scars if left too long. However, medication and technological therapies can tackle acne keloids.

So, just what is acne keloidalis nuchae and how can you go about treating the condition?

What is acne keloidalis nuchae?

Acne keloidalis nuchae (AKN) is a skin condition that affects the neck and upper back, usually around the hairline. Despite the name, it is not actually a type of acne.

AKN appears as itchy, raised red bumps across the back of the neck or affected area. These itchy bumps are blocked hair follicles, usually where hair has ingrown. Over time, these lesions can scar over, leaving permanent keloid scars.

Symptoms include:

  • Itchy bumps on the back of the neck.
  • Pustules forming around the hairline.
  • Itchy bumps turning into keloid scars or large, raised patches of scarring.

Acne keloidalis nuchae vs other acne

The condition is different from more common forms of acne. AKN is in fact more related to folliculitis and other follicle-related issues. Some other differences include:

  • Acne keloidalis nuchae is caused by ingrown hairs, unlike the bacteria and sebum that block pores during an acne flare-up.
  • Common acne may have links to diet, environmental factors, and stress – whereas AKN is usually linked to hereditary factors.
Arab woman wearing a hijab and smiling to represent Acne keloidalis nuchae

What causes it?

Keloid acne on the back, chest, shoulders and head can have several causes.

Heritage and Genetics

It is more common among people of African and Afro-Caribbean heritage, especially if you have a darker skin tone. People of other heritages, including white and Hispanic, have been known to get keloid acne, though less regularly.

The condition is particularly prevalent among young men; they are 20 times more likely to develop keloid acne than women.

You are also more likely to suffer acne keloids if there is a family history of the condition.

Age and Hormones

As with other types of acne-related conditions, age plays a factor in acne keloidalis nuchae. Younger men, those aged between 14 and 25, are more susceptible to the condition.

Hormonal imbalances and the production of testosterone during puberty can contribute to the likelihood of acne keloids. The condition is less common in older people but, as with post-adolescent acne, is possible.

Heat or humidity

Excess sweating is more likely to clog pores and follicles, which in turn can push growing hair inwards.

Other possible reasons for getting acne keloidalis nuchae

  • Haircuts – close-shaves and cuts can damage the skin, which might promote the ingrown hair that leads to the condition.
  • Medications – some medicines, such as cyclosporin, may be linked to acne keloids.

How to prevent it

If you think you may be predisposed to the condition, there are some measures you can take to avoid getting it:

  • Avoid close fitting caps, helmets, or clothing.
  • Don’t wear your hair too short or shaven.
  • Use benzoyl peroxide-based shampoos.
Image of a woman to represent Acne keloidalis nuchae

How you might treat acne keloidalis nuchae?

Acne keloidalis nuchae is a relatively common skin condition and is treatable with several methods.

Creams or solutions

There is a range of creams, solutions, and ointments available to help both treat acne keloids and reduce their appearance.

  • Cortisone cream can help with itchiness.
  • A retinoid cream can alleviate symptoms if started early.

Medications

Depending on the severity of your case, you might be able to get over-the-counter medicine for your acne. However, if you’ve had your condition for a while, your doctor might be able to prescribe something stronger.

  • Antibiotics are often prescribed to reduce infection and inflammation.
  • An oral steroid might be the best bet for more troublesome cases.

Laser therapy

Laser therapy has been shown to reduce the appearance of acne keloids by up to 50 per cent within two months of a first procedure.

Laser therapy works by targeting the ingrown hair and blocked follicles, using non-invasive heat therapy to break down the blockages and alleviate scarring.

Light therapy

As with laser therapy, high intensity, microscopic light beams can be used to break down follicle blockages and help tackle acne keloids and any subsequent scarring.

Surgery

In some cases, you might require surgery to treat your keloidalis. Surgical incisions can be used to physically remove patches of keloid scarring, while cryotherapy is also regularly used to freeze keloid scars until they fall off naturally.

Acne keloidalis nuchae facts

  • Curly hair increases the chances of acne keloids, as growing hair naturally curls inwards while under the skin.
  • Historically, corrosives, acids and engine oil have been used to treat acne keloids. In fact, these just cause larger lesions.

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