What is AKN: Acne Keloidalis Nuchae (AKN) is a disfiguring, painful skin disease that causes scarring and irritation of the scalp. AKN causes hair follicles to become inflamed and develop bumpy lumps and scars. It often manifests as bumps and lumps on the back of the head or neck. However it presents, the condition is persistent and worsens with time. It afflicts young men of color and is far rarer in women.
Typically, the first time patients hear the term “Acne Keloidalis Nuchae (or AKN)” is when they consult a dermatologist. Many patients would make the connection with instances of head shaving, hence resort to calling it “razor bumps,” even “barber’s rash” on the back of the head or neck. The specific location of Acne Keloidalis Nuchae is the nape area of the scalp and neck. However, this condition can be widespread in severe cases and affects the entire scalp surface.
UPDATE: January, 2024
Read more on a hidden AKN precursor in this Clinical, Cosmetic and Investigational Dermatology publication.
UPDATE: July, 2022
To further advance the understanding of Acne Keloidalis Nuchae and its diagnosis and treatment, Dr. Sanusi Umar, MD, has published a new AKN classification system in this medical journal.
With his colleagues from Harbor-UCLA Medical Center, Dr. Umar proposed a standardized and objective AKN classification system to help reliably predict the quality of AKN treatment outcomes by pairing patients with the most appropriate and optimal therapeutic methods. This is a significant milestone in AKN research and will help patients and doctors diagnose and treat AKN with improved understanding and success rates.
Is The Name Acne Keloidalis Nuchae Accurate?
Acne keloidalis nuchae were first documented in the 1800s. The name is now considered a misnomer derived for the following reasons:
- Acne: Because of the manifestation of pimply lesions that sometimes discharge pus
- Keloidalis: Because of the potential for the lesion to grow into a mass consisting of scar tissue
- Nuchae: Because the lesions are typically located in the nape (nuchal) area
The only proper name derivation is the nuchae part. We now know that these bumps on the back of the head are neither a case of acne nor a keloid. Despite this understanding, the scientific community retains the misleading name “Acne Keloidalis Nuchae” for historical reasons. Other less commonly used medical terms exist, such as dermatitis papillary capillitii, folliculitis keloidalis, sycosis nuchae, sycosis frambesiform, and keloidal folliculitis.
What are the Symptoms of Acne Keloidalis Nuchae or AKN?
The patient would typically report any one or a combination of the following signs and symptoms:
- Pimply bumps on the back of the head and neck
- A back of head bump that has multiplied, grown, or merged into a large, flat lesion
- Tumor-like growth that appears similar to a keloid
- Pain
- Itching
- Discharge of pus or blood
- Malodorous smell
Wondering if the bumps on the back of your head are the symptoms of AKN? Schedule a free consultation with Dr. Umar to learn more:
The symptoms of Acne Keloidalis Nuchae typically form what looks like razor bumps on the back of the head and neck. These symptoms can spread over the entire posterior and occipital scalp if they continue to go untreated. Additionally, the physical symptoms that manifest with the onset of AKN can trigger some psychological symptoms and effects. Individuals who develop AKN can experience psychological impacts, including:
- Depression
- Paranoia
- Loss of self-confidence
Can Acne Keloidalis Nuchae (AKN) Symptoms Worsen Over Time?
These symptoms, like the physical symptoms of Acne Keloidalis Nuchae, can worsen over time if a patient goes undiagnosed and untreated.
Dr. Umar developed a classification system that recognizes the different manifestations of the varying types of lesion forms and the different areas and sizes of AKN (meaning the distribution of bumps on the back of the head and neck). This “barber’s rash” on the back of the head and neck is technically referred to as pimples (less than 1cm in diameter), nodules (more than 1cm in diameter), merged papules, and nodules, keloids, or tumor-like masses, or a flat plaque. Each of these different types of lesions varies in how they are distributed across the scalp ranging from stage one to stage four in size and distribution, as seen in the chart below.
What Causes Acne Keloidalis Nuchae Bumps On The Back Of The Head To Form?
The exact causes of AKN are not clear. Many medical experts still debate how this lump on the back of the head and neck forms in the first place. Some experts say incorrect hair growth after shaving too close to the skin may cause folliculitis. In patients prone to AKN, follicles swell and then create a single back-of-head bump, eventually evolving into something resembling razor bumps on the back of the head.
Shaving hair that is already short irritates and increases an individual’s chances of developing AKN if they are genetically predisposed to this condition. Inflammation of hair follicles while shaving areas like the back of the head or the neck can result in thick scars and bumps, categorized as blemishes. AKN first manifests as these bumps on the back of the head, requiring treatment immediately to resolve. If the condition is not treated, the growths eventually combine into a single keloidal tissue mass.
Dr. Umar believes that the condition of AKN is primarily hormone-based. Dr. U’s opinion is based on the fact that many AKN patients tend to develop other DHT-influenced conditions, such as acne vulgaris. AKN predominantly affects men compared to women, who have less DHT activity than men.
Dr. U believes bacteria play a very insignificant role in the etiology of AKN. Although secondary infections can occur, it is a rare phenomenon. According to Dr. Umar, the bumps from AKN are typically the result of sterile inflammation, not due to microbes.
Who Might Develop Acne Keloidalis Nuchae?
Researchers show that AKN typically affects men ages 13-25 of African descent. This is because they are likelier to have tightly curled, short, coarse hair. Other races, including Hispanics and Asians, can also be affected by Acne Keloidalis Nuchae to a lesser degree. AKN is very rare in Caucasians and is extremely rare in women. The ratio of men to women suffering from this skin condition is an estimated 20:1.
Pathobiology: How Do AKN Lesions Form?
AKN may develop due to the immune system’s failure to discern the body’s hair from a foreign, infectious agent. As a result of this mistaken identification, the body becomes inflamed, which then causes bumps to develop on the skin. Fibrosis (thick scar tissue) forms while the skin attempts to heal and repair the damage caused.
Fibroblasts (cells that produce collagen) produce thick scar tissue that distorts and blocks the growth of the hair follicles. The hair shaft becomes trapped underneath the skin, propagating an ongoing cycle of scarring and inflammation. This then causes hypertrophic scar tissue to develop, typically creating bumps on the back of the head that need treatment. Even a single, small back-of-head bump will grow into many more that can join together to form large plaques (flat lesions). Often, they grow to form a more prominent bump on the back of the head and neck that can assume tumor-like or keloidal proportions.
What is the Justification for the Term Razor Bumps on the Back of the Head or Even Barber’s Rash on the Back of the Head?
Does shaving close to the skin affect the onset of AKN? Most patients report an incident of close shaving of the affected areas before the condition’s onset. This leads many sources to posit that AKN might be caused by shaving too close to the skin, friction with the skin, and irritation. Environmental variables damage the hair follicle, breaking it and encouraging the tight, curled shaft to grow back into the skin. One study observed that 90% of individuals affected saw their symptoms manifest after using an electric-powered razor to shave their head or neck.
Dr. U observes that most of his patients have reported close shaving before the emergence of the initial bumps on the back of the head. Dr. U believes the friction encourages the tightly curled shafts of hair to grow back into the skin. This then causes keloids to form on the back of the head.
Acne Keloidalis Nuchae Treatment Methods: How to Treat AKN
If you’re wondering how to get rid of a bump or bumps on the back of the neck and head, the Acne Keloidalis Nuchae treatment recommended for an AKN patient depends on the stage of the patient’s condition. AKN treatment options include:
- Medications: Drugs such as steroids (topical and intralesional) and antibiotics (topical and oral) are typically used to relieve uncomfortable symptoms like itchiness, pain, discharge, and swelling. Antibiotics are, unfortunately, useless. The bumps on the back of the head respond to drug treatment by shrinking in size. However, this remission period is only temporary and not a cure. The patient below shows an example of topical steroids that were partially effective for the first five to six months before the lesions returned.
- Laser treatments: Lasers may be effective for cases where the inciting factor is hair irritation. It is typically effective in small, scattered bumps on the back of the head. It is not effective in well-established nodules, plaques, or masses. There is also the downside of possible hair loss in the treated area.
- Ablation: AKN can be ablated or destroyed using CO2 lasers and liquid nitrogen. Some treatment centers use ablative agents like cantharidin for Acne Keloidalis Nuchae. These treatments, however, typically result in scarring and are not always practical.
- Surgery: Acne Keloidalis Nuchae treatment via surgical removal is perhaps the most effective and potentially curative treatment if correctly performed on suitably selected patients. This approach suits those who have just begun noticing symptoms like razor bumps on the back of the head (although laser would likely be attempted first) and those with flat plaques.
How effective are these AKN treatments?
The general treatment field had previously lacked objective patient criteria for deciding which surgical method to use. This often resulted in final cosmetic results that were less than satisfactory for most patients. Examples include highly noticeable scarring as well as recurrence of lesions. To solve these problems, Dr. U has developed a system for qualifying individuals for specific surgical and laser interventions, enabling them to benefit from better and more predictable long-term outcomes. He has also innovated upon existing methods to help patients achieve significantly improved cosmetic results that are less conspicuous, helping them to feel more confident in social situations. His work has been published in JAAD (Journal of the American Academy of Dermatology) and PRS (Plastic and Reconstructive Surgery) Global Open.
Dr. Umar’s Customized Approach to AKN Treatment
Dr. U innovates surgical and laser methods for effectively treating AKN. This results in actual cures for the majority of his patients. The techniques Dr. Umar employs for Acne Keloidalis Nuchae removal include:
- excisions with tension sutures assisted second-intention healing
- posterior hairline migration
- Trichophytic closure
Dr. U has effectively transformed the lives of many patients who suffer from AKN for the better, enabling them to be free of their limiting condition. Additionally, he makes Acne Keloidalis Nuchae treatment for adults as cost-effective as possible.
Dr. U is recognized globally as a leader in Acne Keloidalis Nuchae treatment. He is consulted by patients worldwide complaining of “razor bumps on the back of the head.” Dr. U’s esteemed reputation in AKN treatment comes from the surgical technique he developed, referred to as the “Batman excision” due to its unique shape. The uniquely shaped excision method enables the complete excision of lesions in qualified AKN patients with an aesthetically pleasing outcome.
Dr. Umar has also expertly managed early forms of the disease with targeted laser treatments.
Unlike conventional treatments that bring only temporary benefits like medications, steroid injections, and Acne Keloidalis Nuchae creams, Dr. U’s unique excision technique and laser therapy treatments typically result in permanently curing almost any size lump on the back of the head and neck. With Dr. U’s expertise, an AKN cure for most patients is possible.
Dr. U’s Surgical Approach for Treating Acne Keloidalis Nuchae
Dr. U has evolved conventional surgical approaches to treat Acne Keloidalis Nuchae to help patients achieve better long-term cosmetic results. Before these advancements, no objective criteria existed for qualifying individuals for specific surgical techniques. Dr. U believes this is why the quality of outcomes varied across patients, and sometimes with somewhat unpredictable results. To overcome these issues, Dr. U developed systems for selecting patients based on quantifiable factors to match AKN sufferers with practical methods for their particular presentation.
Additionally, he has targeted his excision methods for two specific types of Acne, Keloidalis Nuchae lesions.
(1) Lesions less than or equal to 2.5cm in vertical width, located in the upper nuchal area
(2) Lesions less than or equal to 3.0cm in vertical width, located in the lower nuchal area
Dr. U’s Novel Use of Primary Trichophytic Closure For AKN Lesions in the Upper Nuchal Region
Patients with Acne Keloidalis Nuchae lesions located in the upper part of the general nuchal area that is less than or equal to 2.5cm qualify for primary excision and closure techniques where the edges of the wound can be sutured together during the surgical procedure. Dr. U also incorporates Trichophytic closure as a new surgical innovation within the context of AKN procedures. This involves cutting the upper (i.e., superior) wound edge at an angle to be more seamlessly superimposed over the bottom (i.e., inferior) wound margin and decapitated hair follicles. The result is a thinner linear scar through which the patient’s hair grows. Dr. U’s work has been published in JAAD in an article entitled Innovative Surgical Approaches and Selection Criteria of Large Acne Keloidalis Nuchae Lesions.
Dr. U’s Batman Excision and Use of Tension Sutures for AKN Lesions in the Lower Nuchal Area
Large, coalesced AKN lesions that are less than or equal to 3.0cm in vertical width and located in the lower part of the nuchal area can be effectively removed using Dr. U’s Batman excision technique. A more cosmetically inconspicuous scar can be rendered as a straight, horizontal line aligned with the posterior hairline. Performing an excision in the shape of a spread-eagle bat (as opposed to an ellipse) is a practical approach to attaining this objective. Also, tension sutures enable the edges of the wound to close in a more controllable and predictable manner. This methodology and its patient selection criteria have been reported in PRS Global Open within the publication Innovative Surgical Approaches and Selection Criteria of Large Acne Keloidalis Nuchae Lesions.
Photos: Dr. U Acne Keloidalis Nuchae Surgery Results
Surgical removal is the optimal treatment for patients experiencing painful, itchy bumps on the back of the head. Surgical excision has proven to be the most effective and reliable way of removing tumors and plaques. The affected area must be excised by reaching and removing the base of the keloidal tissue and the affected follicles. The type of treatment in most cases is influenced by several factors, including the severity of the AKN symptoms.
Following a thorough assessment, Dr. U develops a targeted course of action with techniques such as excision (complete or partial), Trichophytic closure, and posterior hairline migration.
Photos: Before and After Acne Keloidalis Nuchae Surgery
When conducting surgical Acne Keloidalis Nuchae removal, Dr. U strategically positions the surgical wound to form a linear scar in line with the posterior hairline.
Acne Keloidalis Nuchae: before and after. These images highlight an AKN patient who opted for surgical treatment with Dr. U.
Video: Dr. U Acne Keloidalis Nuchae Surgery Results
The next video features a patient for whom Dr. U performed an excision with Trichophytic closure.
14 Years After Break Up with AKN Bumps, This Man Is Happy
Schedule a free consultation now: https://bumpinator.com/bumpinator-akn-free-consultation-form/ View more patient results here: https://bumpinator.com/patient-results-testimonials/ This #Nigerian gentleman came to me, Dr. Bumpinator (aka Dr. Sanusi Umar), after decades of battling back of head bumps. He had become fed up after no longer being able to enjoy his favorite Sunday church routine because he would always wonder if the congregation seated behind him were staring at the back of his head.
Laser Treatment Results for Bumps on the Back of the Head
If hair shafts cause the initial bumps on the back of the head, a laser can be an effective Acne Keloidalis Nuchae treatment method. Therapeutic approaches using hair-removing ND: YAG lasers have been tested by researchers. These laser treatment tests culminated in a study that shows efficacy in treating papular and even plaque stages of AKN disease.
In one study, 16 patients treated in 5 sessions achieved remission of over 90% in AKN in the papular stage. After 5 treatments, flat plaque disease showed 70% improvement with flattening of the plaques and a reduction in the size of the lump on the back of the head and neck. Dr. U uses the ND: YAG laser for papular AKN removal with positive results. The laser targets the offending hair, removing or weakening it to ensure that it can no longer cut into the skin and restart the hair stab-irritation-tissue fibrous response cycle.
Dr. U’s Patient Selection Criteria and Advanced Application Techniques For Laser AKN Treatment
Dr. U has developed an objective patient selection system for laser treatment in individuals with early-stage Acne Keloidalis Nuchae. In this phase, the lesions manifest as individual papular nodule bumps. However, Dr. U recommends using a laser for lesions less than or equal to 2mm in vertical height. Furthermore, since there is a wide variation in the spread of these bumps on the back of the patient’s head, Dr. U has also developed categories of laser applications based on the severity of the AKN spread. Before this, the general technique used involved the application of a laser to individual bumps. The drawback to this approach was a patchy appearance and spots of baldness surrounded by hair.
By applying the laser to remove hair zones, patients would have a slightly raised posterior hairline above the treated region when the spread is restricted to the nape area. This would allow individuals to maintain a more uniform and natural-looking coverage while resolving their AKN lesions.
Cases, where the spread is more extensive throughout the scalp can either be entirely or partially epilated, depending on the patient’s choice. Many individuals prefer to have some hair remaining, and this approach allows that option.
More information on Dr. U’s selection criteria, treatment zones, and overall methodology for applying laser can be found in his JAAD publication, Selection criteria, and techniques for improved cosmesis and predictable outcomes in laser hair removal treatment of Acne Keloidalis Nuchae.
Photos: Before and After Results of Acne Keloidalis Nuchae Treatment With Lasers
Acne Keloidalis Nuchae Before and After ND: YAG Laser Treatment with Dr. U.
Video: Results of Acne Keloidalis Nuchae Laser Treatment by Dr. U
The following video features a patient who received a series of laser treatments from Dr. Umar. This particular approach resulted in the permanent removal of AKN, which he thought to be razor bumps on the back of his head.
Laser Treatment For AKN Red Bumps on Back of Head
To learn more about this case, visit: https://dru.com/acne-keloidalis-nuchae/acne-keloidalis-nuchae-treatment-with-laser-los-angeles-patient-cured/ This patient had tried various other non-surgical treatments for his red AKN bumps on the scalp. However, none had proved effective. Unhappy with the cosmetic appearance of these bumps, the patient consulted Dr. Umar about his options.
Frequently Asked Questions: Acne Keloidalis Nuchae
How do I determine if the lump on the back of my head and neck is AKN?
To rule out other skin conditions, it’s essential to receive a diagnosis from a doctor who specializes in Acne Keloidalis Nuchae. Diagnosis starts with recognizing AKN signs: the characteristic bumps on the back of a single large bump on the back of the head and neck. Next, the doctor would take a biopsy for histologic diagnostic confirmation of clinical suspicion. A histologic report is the final and definitive diagnostic tool for AKN.
How do I eliminate bumps on the back of my neck and head using a home remedy?
When treating this medical condition, no AKN home remedy is effective. Again, the causes of AKN are very complex. The condition may be due to issues like hormones, genetics, and inflammation of the hair follicles. Individuals seeking treatment for bumps on the back of the head and neck should turn to laser, surgical, or medical treatments discussed here.
How to get rid of a large bump on the back of my head and neck: is there such a thing as a cure for Acne Keloidalis Nuchae?
Yes. According to Dr. U’s experience, there are two instances of therapeutic cures using current treatments:
- Surgical treatment if the lesions in an area are amenable to complete removal
- Laser treatment in early-stage disease state: Using the correct laser in combination with prescription Acne Keloidalis Nuchae creams, Dr. U has successfully cured the bump on the back of the head and neck for several AKN patients.
What is the cost of Acne Keloidalis Nuchae removal surgery?
The cost should vary with the kind of lesion and the extent of the surgery needed. To determine the cost of your surgery, seek a complimentary consultation from most doctors who offer the procedure, like Dr. U. Following evaluation, you will be provided with a detailed treatment recommendation and associated costs, potentially including other services such as sending your AKN lesion to a pathologist. Considering the transforming and freeing experience expressed in videos by Dr. U’s patients, the cost is well worth the expenditure.
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References
- Fibroblast – Wikipedia. En.wikipedia.org. https://en.wikipedia.org/wiki/Fibroblast. Published 2022. Accessed July 28, 2022.
- Intralesional steroid injection | DermNet NZ. Dermnetnz.org. https://dermnetnz.org/topics/intralesional-steroid-injection. Published 2022. Accessed July 28, 2022
- Umar S, David CV, Castillo JR, Queller J, Sandhu S. Innovative Surgical Approaches and Selection Criteria of Large Acne Keloidalis Nuchae Lesions. Plast Reconstr Surg Glob Open. 2019;7(5):e2215. Published 2019, May 16. doi:10.1097/GOX.0000000000002215
- Umar S, Lee DJ, Lullo JJ. A Retrospective Cohort Study and Clinical Classification System of Acne Keloidalis Nuchae. J Clin Aesthet Dermatol. 2021;14(4):E61-E67.
- Umar S. Selection criteria and techniques for improved cosmesis and predictable outcomes in laser hair removal treatment of acne keloidalis nuchae [published correction appears in JAAD Case Rep. 2019 Aug 29;5(9):809]. JAAD Case Rep. 2019;5(6):529-534. Published 2019 Jun 8. doi:10.1016/j.jdcr.2019.02.034
