Acne Keloidalis Nuchae: What It Is, Why It Develops, and How It Is Treated
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: September 2026
Editorial note: This article is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a licensed healthcare provider for personal medical decisions.
TL;DR
Acne keloidalis nuchae (AKN) is a chronic skin disorder in which inflamed hair follicles on the back of the neck and scalp form red bumps that can grow into thickened scars and cause hair loss. It affects men with curly hair far more often than anyone else — roughly 20 men for every 1 woman — and most often begins between ages 14 and 25. There is no cure, but antibiotics, retinoids, steroid injections, and in severe cases surgery can control symptoms and slow progression.
Quick Answer
Acne keloidalis nuchae is a chronic inflammatory condition of the hair follicles at the back of the neck and scalp that starts as itchy red bumps and can progress to firm keloid-like plaques, scarring, and permanent hair loss. It most commonly affects men of African descent with curly hair, usually beginning after adolescence. While no cure exists, early treatment with topical or oral antibiotics, retinoids, and steroids can ease symptoms and prevent worsening; severe cases may require surgical removal. Avoiding close shaving and neck irritation is the single most important self-care step.
What Is Acne Keloidalis Nuchae?
Acne keloidalis nuchae (AKN) is a form of folliculitis — inflammation of the hair follicles. It targets the follicles at the back of the neck and the back of the scalp, the hair-bearing skin covering the head [1].
Over time, AKN can cause progressively worsening skin problems in that area, including scarring and hair loss.
Despite the name, the condition is not true acne, and the scars are not true keloids under the microscope. It is a form of chronic scarring (cicatricial) alopecia — hair loss caused by inflammation that permanently destroys hair follicles [2] [5].
The condition has carried many names over the years, which is why it may appear in medical records under several different terms.
Name you may see | What it means |
Acne keloidalis nuchae (AKN) | The most common modern name |
Acne keloidalis | Older shorthand |
Folliculitis keloidalis nuchae | The technically more accurate name (preferred by some dermatologists) |
Dermatitis papillaris capillitii | The earliest formal name (1869) |
Sycosis framboesiformis | The very first name ever used (1860) |
Who Gets Acne Keloidalis Nuchae?
Anyone can develop this type of folliculitis. But the condition is strikingly uneven in who it affects [1].
Factor | How it changes the risk |
Sex | Men are affected about 20 times more often than women [2] [3] |
Ethnicity | Most common in people of African descent, especially African American men [2] [3] |
Hair type | Much more common in men with curly hair [1] |
Age | Most cases begin between ages 14 and 25; rare before puberty and rarely develops after age 50–55 [3] [4] |
How common is it exactly? Estimates vary by population. In African American adults, reported prevalence ranges from about 0.5% to 13.6%, with the highest figure found in a study of football players who wore headgear — none of the White athletes wearing the same headgear developed AKN, while 13.6% of the Black athletes did [3] [5]. Researchers estimate AKN accounts for roughly 0.45% of all skin conditions seen in Black patients [5].
Population studied | Reported prevalence |
African American adults (range across studies) | 0.5% – 13.6% |
Black American football players wearing headgear | 13.6% (vs. 0% of White players with the same headgear) |
Nigerian dermatology consultations | Up to 9.4% of visits |
South African schoolboys (final year) | 4.7% |
South African older men | 10.5% |
Sources: [3] [5] [6]
What Causes Acne Keloidalis Nuchae?
Scientists are not certain what starts AKN, and the true name for the disease reflects that uncertainty — most experts now believe it is not really a form of acne at all [5].
Current thinking points to a combination of factors that irritate or injure the hair follicles at the nape of the neck [1] [2] [3]:
Possible cause | Explanation |
Friction and trauma | Helmets, tight shirt collars, CPAP mask straps, and neck chains repeatedly rub the nape [2] [5] |
Haircut practices | Very close shaves and clippers cutting more than once a month are strongly associated with AKN [1] [5] |
Immune reactions | Inflammation inside the follicle cells may set the process in motion [1] |
Hormones | Excess androgens (male hormones) or heightened sensitivity to them [1] [2] [3] |
Infection | Chronic low-grade bacteria or Demodex mites, usually a sustaining rather than starting factor [2] [3] |
Medications | Cyclosporine and certain antiepileptic drugs (carbamazepine, diphenylhydantoin) have been linked to AKN-like lesions [2] [5] |
Once the process starts, it tends to sustain itself. One proposed sequence of events is that acute inflammation weakens the follicle wall, the hair shaft escapes into the skin where it acts like a foreign body, ongoing inflammation triggers fibroblasts to deposit collagen, and the resulting fibrosis clogs the follicle and traps hairs — creating a permanent cycle of inflammation, scarring, and hair loss [2] [5].
What Are the Symptoms?
AKN usually begins with red, itchy bumps (papules) or patches of skin. The bumps tend to become infected because of scratching, forming pustules — small pockets of pus that look almost like pimples [1].
Early symptoms include:
Itchy, red bumps on the back of the neck and scalp
Pimple-like pustules
Itchiness that appears hours to days after a haircut
Later symptoms as the condition progresses:
Crusty feeling on the skin
Pain and tenderness
Plaques — thickened, scaly patches
Thickening and scarring of the skin and hair follicles (fibrosis, hypertrophic scars, keloid-like plaques)
Tufts of hair loss (scarring alopecia)
In advanced cases, abscesses and sinus tracts — small tunnels under the skin — can form, sometimes with pus draining from the area [5].
Stage | What you see |
Early | Red, itchy papules and pustules on the nape |
Middle | Bumps merge into firm, raised papules |
Late | Firm keloid-like plaques, scarring, tufted hairs, hair loss |
Advanced | Abscesses, sinus tracts, draining pus |
How Is Acne Keloidalis Nuchae Diagnosed?
There are no perfect tests for AKN. A healthcare provider can usually diagnose the condition based on a physical exam of the neck and scalp, combined with your history [1].
The provider will ask about your symptoms, when they started, whether they have changed over time, what seems to irritate your skin, and what treatments you have already tried [1].
If the diagnosis is not clear, the provider may recommend additional testing [1] [2]:
Diagnostic step | What it establishes |
Physical exam | Location, texture, and appearance of lesions — usually enough for diagnosis |
Skin biopsy | A small skin sample examined under a microscope to rule out psoriasis, skin cancer, or other scarring conditions |
Culture | A swab to identify bacteria if the lesions seem infected, which guides antibiotic choice |
What Are the Treatment Options?
There is no cure for AKN, so treatment focuses on easing symptoms, preventing infection, and slowing progression [1] [2].
Because there is no single established first-line therapy, providers individualize treatment based on disease stage [2] [5].
Treatment | When it is used |
Topical antibiotics (creams, washes) | Early disease; prevents or treats bacterial infection [2] |
Oral antibiotics (minocycline, doxycycline) | Active folliculitis with pustules [2] |
Retinoids (vitamin A derivatives) | Improves symptoms and softens coarse hairs [1] [2] |
Topical steroids (creams) | Early papular stage to calm inflammation [1] [2] |
Intralesional steroid injections (triamcinolone) | Hard, raised papules — shrinks and softens them [2] |
Oral isotretinoin (moderate dose) | Anti-inflammatory effect on folliculitis; less effective for hard plaques [2] |
Laser therapy | 1064 nm Nd:YAG and 810 nm diode lasers are most effective; small studies report 82–95% therapeutic response [2] [7] |
Phototherapy (targeted UVB) | Three sessions per week for 8–10 weeks; well tolerated in small studies [2] [7] |
Surgical excision ± skin grafting | Severe, extensive plaques [1] [2] |
Radiotherapy | Only for cases resistant to every other treatment [1] [2] |
Self-care and home measures also play a major role [1] [5]:
Apply diluted apple cider vinegar or tea tree oil to the skin to help prevent infection (mix one part vinegar or tea tree oil with three parts water)
Avoid clothing, hats, helmets, or haircuts that irritate your skin
Clean the area with antimicrobial cleansers
Rub aloe on the skin to soothe and cool it
Ask your barber to avoid close shaves at the nape of the neck and back of the scalp
Can Acne Keloidalis Nuchae Be Prevented?
Because the exact cause of AKN is not understood, there are no proven ways to prevent it entirely [1].
However, certain measures may reduce symptoms and help prevent the condition from developing or recurring [1] [2] [5]:
Avoid very close shaving at the back of the neck and scalp
Ask barbers to leave more hair length in the affected area
Avoid frequent haircuts (more than once a month has been associated with higher risk)
Avoid tight shirt collars, hard hats, helmets, and headgear that rub the nape
Remove neck chains and other irritants from the area
Do not pick, rub, or scratch the affected skin
What Is the Outlook?
AKN is a chronic condition without a cure, so it often lasts a lifetime [1]. The goal of treatment is to manage symptoms, prevent infection, and slow the progression of the disease.
The outlook is meaningfully better with early treatment. If AKN is caught and treated in the papular stage, prognosis is good. Once significant scarring has developed, treatment becomes far more difficult, and most patients are left with a lasting cosmetic concern [2] [5].
Surgical outcomes are encouraging but not perfect — a 2025 systematic review of surgical management found recurrence in about 19% of cases, though most recurrences could be managed conservatively [8].
When Should You See a Healthcare Provider?
Talk to a healthcare provider anytime skin problems are bothering you or interfering with your life [1].
With AKN, your skin is at elevated risk for infection. Seek medical attention promptly if you develop any of the following [1]:
Fever
Pus draining from the area
Swelling or pain that worsens over several days
Conclusion
Acne keloidalis nuchae is a chronic inflammatory condition of the hair follicles that silently reshapes the back of the neck and scalp. What starts as a few itchy bumps after a close shave can, over years, become firm keloid-like plaques with permanent hair loss. It disproportionately affects men with curly hair — roughly 20 men for every 1 woman — and usually begins in the teens and twenties. While no cure exists, the condition is very treatable when caught early: antibiotics, retinoids, steroid injections, and targeted laser therapy can control symptoms and halt progression, and surgery remains an option for severe cases.
If you have noticed persistent itchy bumps at the back of your neck — especially after close haircuts or helmet wear — do not wait for scarring to develop. Schedule an evaluation with a dermatologist; early treatment is the single best predictor of a good outcome.
Frequently Asked Questions
What does acne keloidalis nuchae look like?
It starts as small red, itchy bumps (papules) on the back of the neck and scalp that look like pimples. Over time the bumps merge into firm, raised, keloid-like plaques, and hair loss appears within and around the plaques.
Is acne keloidalis nuchae contagious?
No. AKN is not an infection that spreads between people. However, sharing razors or clippers with someone who has actively bleeding lesions can pose a risk of transmitting blood-borne infections — use your own clean equipment.
Can acne keloidalis nuchae go away on its own?
No. AKN is a chronic condition without a cure. It tends to persist and slowly worsen over years unless treated. Early treatment is the best way to prevent progression to scarring.
Does acne keloidalis nuchae cause permanent hair loss?
The hair loss is permanent in areas where scarring has developed, because inflammation destroys the hair follicles. This is why treating the condition before plaques form matters so much.
Can women get acne keloidalis nuchae?
Yes, but rarely. Men are affected about 20 times more often than women, and the condition occurs mainly in people of African descent with curly hair.
Is acne keloidalis nuchae the same as razor bumps?
No, though they are related. Razor bumps (pseudofolliculitis barbae) are caused by ingrown hairs from close shaving and do not typically cause scarring. AKN involves chronic inflammation that destroys follicles and produces permanent keloid-like scars.
What is the best treatment for acne keloidalis nuchae?
There is no single best treatment. Early disease responds to topical antibiotics, retinoids, and steroid creams. Hard bumps respond to steroid injections. Severe plaques may require laser therapy or surgical excision. A dermatologist will tailor the plan to the stage of disease.
Can I shave my neck with acne keloidalis nuchae?
It is safest to avoid close shaving at the nape of the neck and back of the scalp. Ask your barber to leave more length in the affected area and to avoid cutting more than once a month if possible.
References
Cleveland Clinic. Acne Keloidalis Nuchae. Medically reviewed; last updated May 2, 2022.
Al Aboud DM, Badri T. Acne Keloidalis Nuchae. StatPearls. Last updated July 31, 2023.
Ogunbiyi A. Acne keloidalis nuchae: prevalence, impact, and management challenges. Clin Cosmet Investig Dermatol. 2016;9:483-489.
Satter EK. Acne Keloidalis Nuchae (AKN). Medscape eMedicine. Updated April 22, 2026.
Medscape eMedicine. Acne Keloidalis Nuchae (AKN) — Background, Pathophysiology, Epidemiology. Updated April 22, 2026.
Salami T, Omigbodun AA, Ogedengbe JO, et al. Prevalence of acne keloidalis nuchae in Nigerians. J Eur Acad Dermatol Venereol. 2007;21(5):637-640.
Maranda EL, Simmons BJ, Nguyen AH, et al. Treatment of acne keloidalis nuchae: a systematic review of the literature. Dermatol Ther (Heidelb). 2016;6(3):363-378.
Hinson C, Sink M, Odobescu A, et al. Surgical management of acne keloidalis nuchae: A systematic review of outcomes and techniques. J Plast Reconstr Aesthet Surg. 2025;104:102-112.
American Academy of Dermatology. Acne keloidalis nuchae: Causes. Published July 28, 2022.
DermNet. Folliculitis keloidalis. Peer-reviewed dermatology resource.
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