PERSISTENT ACNE NODULES ON NECK

Q I’m 37 years old, Egyptian, male, suffering from persistent acne like nodules on my upper neck/lower back of my scalp since last several years. Please help.

You are likely suffering from acne keloidalis nuchae (AKN). Some doctors may also refer to it as pseudofolliculitis barbae. AKN is believed to be primarily affecting the genetically predisposed individuals, mainly of African origin with curly hair. The exact cause of this condition is not fully clear, however the obliquely positioned and partially twisted hair follicles are believed to produce severely curly hair shafts which can reinvade the skin during their growing process causing commonly known ingrown hair disorder. This in turn initiates an irritant inflammatory reaction in the affected areas, as such leading to the formation of persistently inflamed papules, nodules and sometime cystic lesions.

Very shortly trimmed hair on the affected areas and a frictional irritation of the involved skin by wearing high-neck collared shirts make the condition more persistent.

Treatment of AKN usually poses a serious challenge because routine acne treatments mostly prove ineffective. A combination therapeutic approach may be required. This includes performing intralesional steroidal dermal injections around inflamed follicles, together with short courses of low dose oral steroids in severe cases. A course of oral medication may also be required. As such this makes the duration of the treatment to vary among individual patients. This treatment needs a close monitoring of the patients. The standard treatment monitoring protocol includes regular blood tests in addition to close clinical observation and detailed interaction between the patient and the dermatologist. This is necessary to ensure the highest safety levels during treatment.