Acne keloidalis nuchae—also known as keloidal folliculitis—is a chronic skin condition that can be difficult to treat. However, by understanding its causes, taking the proper preventive measures, and seeking medical help, you can get your symptoms under control and improve your chances of enjoying clear skin again. Here, Curology’s expert dermatology providers will explain everything you need to know about this condition.

Here at Curology, we currently focus on the diagnosis and treatment of acne, rosacea, and anti-aging concerns. We do not treat many of the conditions mentioned in this article. This article is for information purposes.

Acne keloidalis nuchae (AKN) is a persistent skin disorder characterized by continuous inflammation of the hair follicles at the back of your neck. This inflammation results in the development of keloid-like scars and may eventually cause hair loss due to hair follicle damage. 

As AKN advances, the impacted skin regions become inflamed, thickened, and scarred. Over time, fibrosis occurs and the existing papules merge together to form keloidal scarring plaques.¹ 

If you have acne keloidalis nuchae, you may experience certain symptoms such as:²

• Itchiness.

• Discomfort.

• The appearance of solid dome-shaped bumps.

• Elevated skin scarring.

• Patches of hair loss.

Let’s take a look at what causes this condition, so you have a better understanding of how you can prevent and treat it.

What causes acne keloidalis nuchae? 

The exact cause of acne keloidalis nuchae is poorly understood and may be attributed to several factors. Donna McIntyre, a nurse practitioner at Curology, notes, “One of the likely contributors to this condition is skin inflammation caused by irritation. This could occur from wearing a helmet, wearing tight collars, or getting a very close shave at the nape of your neck.” 

Specific immune reactions in hair follicle cells may also play a role in causing AKN.³ Research has shown that hormonal imbalances, such as excess androgen hormones or sensitivity to androgen, could also be involved in the development of AKN.⁴

The underlying process of this non-contagious condition involves ongoing inflammation that produces too much collagen and forms fibrous tissue. This blocks the hair follicle and traps the hair inside, causing even more inflammation.⁵ 

Lasting inflammation weakens your hair follicles. When the hair inside this weakened follicle emerges, it can dig into your skin, creating small bumps. If left untreated, the inflammation goes on, leading to scars that cover your hair follicles, and can eventually cause permanent hair loss. As more and more follicles become scarred, keloid-like scars can develop.⁶

Who is most susceptible to acne keloidalis nuchae?

Anyone can get acne keloidalis nuchae; however, research and statistics show that it’s particularly common among men of African descent who often wear sports helmets, durags, or hard hats, or maintain short hair. Although there is still more to learn about AKN, it’s clear that activities that irritate the skin on the back of your neck increase susceptibility. 

You may also be more susceptible to it if you have blood relatives who have the condition or if you’re taking certain medications such as cyclosporine.⁷

The good news is that treatment options are available to help your skin look smoother and clearer.

We advise seeing an in-person dermatology provider for appropriate AKN management. Your provider will likely recommend treatments such as antibiotics, retinoids or steroids, and surgical excision.

Topical or oral antibiotics 

Antibiotics can help you effectively manage acne keloidalis nuchae by treating or preventing bacterial infections and reducing inflammation.

A combination of topical fusidic acid and oral cefadroxil may successfully address these aspects of the condition. Topical fusidic acid helps target bacterial infections on your skin, while oral cefadroxil works systemically to combat infection and inflammation.⁸ 

By combining these two treatments, you increase the likelihood of significant improvement in AKN symptoms and preventing further complications.

Retinoids and steroids 

Retinoids and steroids can also be effective options to address AKN. Retinoids, which are vitamin A derivatives, can help improve AKN symptoms. Oral isotretinoin, a retinoid medication, may help in managing the condition, though data is limited.⁹

Steroids can be administered as creams or injections to help alleviate inflammation associated with AKN.¹⁰ Topical steroid creams work directly on the affected area. In contrast, intralesional steroid injections offer a more targeted approach to reducing inflammation in the specific location of the injection.

Surgical excision and skin grafting

In cases where your acne keloidalis nuchae becomes severe, your healthcare provider may recommend surgical excision as a treatment option. This procedure entails removing the damaged skin sections and replacing them with healthy skin grafts taken from another area of your body. 

Researchers continue to explore alternative treatments for acne keloidalis nuchae, including laser therapy, light therapy, laser hair removal, and radiotherapy.¹¹ 

Preventing acne keloidalis nuchae

Preventing acne keloidalis nuchae (AKN) can be achieved by taking certain precautions and adopting specific habits, such as:¹²

• Avoid close-shave haircuts: Opt for a slightly longer haircut to minimize the risk of hair follicles becoming ingrown or irritated, and when possible, let your hair grow.

• Wear loose clothing and accessories: Avoid tight collars, helmets, or headwear that may cause friction or irritation on the back of the neck.

• Stay dry: Maintain a dry neck area, as heat and sweat can aggravate your skin. Aim to stay cool to prevent further skin irritation.

• Maintain good hair hygiene: Keep your hair and scalp clean by using an antimicrobial cleanser to reduce the risk of bacterial infections that can exacerbate AKN.

• Don’t scratch: Soothe the itchiness associated with AKN by using a cold compress. AKN can cause itchiness; if you scratch, pick at, or rub the affected skin, the condition may worsen. By applying a cool compress, you can alleviate the itch and avoid further irritation.

It's essential to consult a licensed dermatology or healthcare provider if you believe you may be at risk for AKN or experiencing symptoms. They can provide personalized recommendations and help prevent the condition from developing or worsening.

Start your journey towards clear skin

Acne keloidalis nuchae, and acne in general, can be challenging to treat, but using the right products and following an optimal routine makes it much easier to see results. While we don’t offer treatment for acne keloidalis nuchae, we can treat acne, rosacea, and signs of aging like dark spots and fine lines.

Our personalized acne products are prescribed by a licensed dermatology provider who carefully analyzes your skin type and concerns. We consider factors such as skin texture, sensitivity, your medical history, and acne severity to prescribe a personalized formula desgined to meet your skin goals.

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Each custom formula contains a combination of active ingredients such as tretinoin, azelaic acid, clindamycin, niacinamide, and zinc pyrithione, among others. 

In addition to the custom formula, Curology offers a complete skincare routine, including a gentle cleanser and moisturizer, which complement your personalized acne treatment. Consistently using these products as part of your daily skincare regimen can help to improve your skin's overall health and appearance. 

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P.S. We did the homework, so you don’t have to:

1.  Al Aboud DM, Badri T. Acne Keloidalis Nuchae. StatPearls Publishing (2022, August 1)

2.  American Academy of Dermatology. ACNE KELOIDALIS NUCHAE: SIGNS AND SYMPTOMS. (2022, July 28)

3. Maranda EL,et al.Treatment of Acne Keloidalis Nuchae: A Systematic Review of the Literature. Dermatol Ther (Heidelb). (September 2016)

4.  Al Aboud DM, Badri T. Acne Keloidalis Nuchae. StatPearls Publishing (2022, August 1)

5.  Al Aboud DM, Badri T. Acne Keloidalis Nuchae. StatPearls Publishing. Ibid. 

6.  American Academy of Dermatology. ACNE KELOIDALIS NUCHAE:CAUSES. (n.d)

7.  American Academy of Dermatology. ACNE KELOIDALIS NUCHAE:CAUSES. (n.d)

8.  Maranda EL,et al.Treatment of Acne Keloidalis Nuchae: A Systematic Review of the Literature. Dermatol Ther (Heidelb). (September 2016)

9.  Goh MS, et al. Keratosis follicularis spinulosa decalvans and acne keloidalis nuchae. Australas J Dermatol. (November 2005)

10.  American Academy of Dermatology. ACNE KELOIDALIS NUCHAE:TREATMENT. (n.d)

11.   Maranda EL,et al.Treatment of Acne Keloidalis Nuchae: A Systematic Review of the Literature. Dermatol Ther (Heidelb). (September 2016)

12.  American Academy of Dermatology. ACNE KELOIDALIS NUCHAE: SELF-CARE. (2022, July 28)

13.  Al Aboud DM, Badri T. Acne Keloidalis Nuchae. StatPearls Publishing (2022, August 1)

14. McGinty S, Siddiqui WJ. Keloid.StatPearls Publishing. (2022, July 19)

15.  Maranda EL,et al.Treatment of Acne Keloidalis Nuchae: A Systematic Review of the Literature. Dermatol Ther (Heidelb). (September 2016)

    Donna McIntyre is a board-certified nurse practitioner at Curology. She obtained her Master of Science in Nursing at MGH Institute of Health Professions in Boston, MA. 

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Written by

Curology Team

Medically reviewed by

Donna McIntyre, NP-BC