UPDATE: A recent study used Follicular Unit Extraction surgery to successfully treat AKN. Find the study in the references.
Acne Keloidalis Nuchae is an itchy and painful type of folliculitis that forms on the rear scalp, almost exclusively in young men. When the disorder first appears, it is often mistaken for a persistent razor rash, and many try to use natural home remedies or over-the-counter medications. However, these individuals soon find that these remedies fail when the condition has progressed despite their best efforts. Even a visit to the dermatologist for an antibiotic or steroid prescription will only help manage the disease at best. Drug treatments do not offer a cure. Acne Keloidalis Nuchae removal surgery is the only known method for permanently eradicating the bumps, lesions, and plaques that increase due to the condition. Waiting too long to seek medical attention for this disease typically creates more pain and discomfort, both physically and emotionally. The surgical removal of a bump at the back of the head may seem extreme, but it leads to immense long-term satisfaction.
Those wondering “What is the cost of AKN surgery?” must consider the following: What is the cost of NOT pursuing an AKN excision? In most cases, the patient’s mental and emotional health, feelings of physical freedom, and restored self-confidence are priceless–and well worth the financial investment. Clinics specializing in removing AKN will often offer financing and discount options to serve patients best, helping make these procedures more accessible.
Dr. U’s years of study, research, and practice make him a top specialist for AKN removal using surgery and laser treatments.
AKN Surgical Removal – Bumps on Back of Head Treatment
For more information about this case, please visit: https://dru.com/acne-keloidalis-nuchae/surgical-treatment-of-akn-bumps-in-los-angeles-patient/ To consult Dr. Umar online, click here: https://dru.com/acne-keloidalis-nuchae/free-consultation/ This patient came to Dr. Umar in Los Angeles after several other bumps on back of head treatment courses had failed. AKN, or acne keloidalis nuchae, is a condition in which a hair follicle becomes inflamed and bumps form as a result.
When Should Acne Keloidalis Nuchae Removal Surgery Be Considered?
The classification diagram below displays the types of AKN that Dr. Umar identified himself. AKN removal surgery is the most effective when the papules and nodules merge into a single tissue mass. At this point, management with medications and even laser therapy becomes futile. Containment and temporary remission become highly unlikely as the pain, inflammation, size, and severity of the disease worsen.
At What Point Are Bumps on the Back of the Head Too Large for Surgery?
The following diagram below displays how AKN bumps can be distributed on the scalp, as identified by Dr. U. AKN removal surgery cannot be performed in stage IV. Dr. Umar can use his “Batman” technique to align the surgical scar with the posterior hairline when the disease has not spread above or below the occiput line pass-through and nape hairline pass-through. Surgery should be considered if you notice the condition rapidly spreading or if there are growing raised merged bumps and lumps or masses on the back of the head. Consult a dermatologist as soon as possible.
Bumps on the back of the head that look like stages I or II are best for surgery. Surgical removal is still possible for a single large bump on the back of the head.
How to Get Rid of Bumps on the Back of the Head by Surgery: Traditional Methods
Here is a concise explanation for those wondering how AKN can be resolved by surgery at a standard clinic. The excision must be deep enough to remove all inflamed follicles causing the disorder. Once the base of the keloidal tissue is exhumed, long-term remission can realistically be expected. Whether it’s someone with a small lump on the back of the head seeking a surgical cure or someone with a large bump on the back of the head wanting surgical removal, the typical methods for AKN excision include:
- Excision with primary closure
- A combined approach of excision and grafting
- Staged excision using primary closure
- Electrosurgical excision
AKN Removal Surgery with Primary Closure
AKN removal surgery with primary closure is a technique where the surgeon cuts out the tissue in an elliptical shape and then immediately stitches the wound’s edges together. This is a suitable method for small, narrow lesions. More expansive lesions treated this way would result in wider stretched scars.
JAAD (Journal of the American Academy of Dermatology) published an article by Dr.U entitled Patient Selection Criteria and Innovative Techniques for Improving Outcome and cosmesis in Acne keloidalis nuchae lesion excision and Primary Closure. In this publication, Dr.U discusses his innovative technique, which involves trichophytic excision and closure, originating from strip surgery hair transplantation. Within the context of AKN, this approach involves cutting the upper wound edge at a specific angle. Secondly, the lower wound margin is cut to include decapitated hair follicles. Finally, the upper wound edge is positioned to superimpose the bottom margin so that hair grows through, covering the resulting thin linear scar. Patient cases that qualify for primary closure include AKN lesions that are less than 2.5cm in vertical width and located in the upper nuchal region.
Patient Selection Criteria and Innovative Techniques
AKN Excision and Skin Grafting
Excision and grafting is an Acne Keloidalis Nuchae removal surgery method proposed only in theory, not in actual practice. A skin graft would close the wound after the excision; however, this results in a significant mismatch of skin on the rear scalp. The large, bald, grafted skin is also not an aesthetically pleasing result. In 2011, Beckett, Lawson, and Cohen et al. noted that the grafted skin appears cosmetically subpar, as it does not blend with the surrounding skin. Dr. U does not subscribe to this type of surgery.
AKN Staged Excision Using Primary Closure
With staged AKN removal surgery using primary closure, the surgeon removes part of the lesion–each time closing it primarily. This is then allowed to heal, after which another chunk of the remaining lesion is removed and closed primarily again. This continues until the lesion is removed or it is no longer possible to continue due to lack of scalp laxity.
Acne Keloidalis Nuchae Excision with Second Intention Healing
In this approach, the AKN lesion is excised, and the wound is left open to heal. According to Paul Kelly et al., if the posterior hairline is included and the excision is done beyond the depth of the hair follicles, they would contract on their own with an aesthetically pleasing linear scar that forms the boundary of a new posterior hairline.
This highly specialized excision method surgically removes the bump on the back of the head to leave a normal-looking (straight or downward curved) posterior hairline (as opposed to an upwardly curved one). Surgery can achieve the best patient outcome. Again, the objective is to remove the AKN tissue and leave cosmetically insignificant scarring along with a natural-looking hairline along the nape. As a result of these efforts, the patient can feel confident again.
Acne Keloidalis Nuchae – AKN: The Dr. U Approach
Dr.U has an approach to AKN surgery that is customized according to the presentation of the patient:
- Patients with narrow lesions are treated by excision and primary closure using trichophytic closure, with or without tension sutures.
- For patients with more expansive lesions (Stages I, II, and III), he adopts the approach of excision using the “Batman excision” he invented to direct a wound that closes with a straight or a downward curved posterior hairline as well as the use of tension sutures.
A Combined Approach to Acne Keloidalis Nuchae Removal Surgery at Dr. U Skin Clinic
Dr. Umar believes that a combined approach to surgical removal of a bump at the back of the head enables the most effective long-term cure. A strategy is determined based on the differing nature of patient needs. People have varying medical histories, genetic backgrounds, and cosmetic ideals, in addition to the unique way AKN is presented on their scalps. Some patients may want the bump on the back of the head removed in surgery with little need for cosmetic satisfaction. In contrast, some patients require a visually normal-looking scalp with inconspicuous scarring and hair loss. Regardless, Dr. U’s outcome-based approach prioritizes the final aesthetic as much as possible, as this also has a long-term impact on the patient’s mental and emotional well-being.
Because Dr. U has seen so many non-surgical (and surgical) methods fail, he is a strong proponent of using his Batman excision technique and other known therapies or medicines that assist in the removal, cosmetic results, and healing process. For many, he has discovered how to get rid of bumps on the back of the head through surgery alone. Some patient cases may require a combination of treatments, including the following:
- Laser treatment
- Steroid injections
- Topical steroids
- Topical retinoids
Dr. U discusses and maps out the best plan of action to account for individual needs and cost considerations with each patient. Contact Dr. U Hair and Skin Clinic for a free consultation on Acne Keloidalis Nuchae removal surgery.
Expectations After Acne Keloidalis Nuchae Removal Surgery at Dr. U Skin Clinic
AKN patients should anticipate up to 2 months of downtime after their procedure. Wounds left to close by the second intention may require about 6-10 weeks to close post-surgery. Those who’ve removed a big bump on the back of the head through surgery may take longer than those who have addressed a small lump on the back of the head through their operation.
In either case, patients are asked to rest, limit the motion of their head and neck, and follow any other recommendations or care instructions provided by Dr. U.
After the healing process, patients may notice their scar thin, flatten, and normalize in color over time. For many, the scar that results from the procedure is insignificant compared to the prior condition of painful lumps and bumps on the back of the head.
Patients concerned about the cost of the procedure tend to value the improved quality of life after surgery more than the cost. With the condition effectively treated, patients can no longer hide under hats or long hairstyles while enjoying renewed confidence and comfort.
Acne Keloidalis Nuchae (AKN) Surgery: Examples From Dr. U AKN Clinic
Photo: Patient Who Regained Freedom After Acne Keloidalis Nuchae Removal Surgery
This patient suffered from AKN for nearly 10 years. It started as small, pimple-like bumps he treated with acne medications and washes. As the condition worsened, he sought the care of a dermatologist, who prescribed him an oral tetracycline. The condition worsened gradually until the bumps gradually formed into a large mass. He experienced pain, itching, and discharge of pus daily. Getting rid of the large bump on the back of his head by surgical removal proved highly successful only five months post-surgery, and the patient is thrilled with the results.
In his words, the life-changing difference is “Taking my kids to the beach. Going swimming in a swimming pool. Letting people see me without having to hide. Wearing a nice shirt and exposing the back of my head. I’ve got my freedom back.” Watch his video of the results below.
Video: Large Bump on Back of Head Surgical Removal at Dr. U AKN Clinic
Watch this video and listen to what Dr. Umar and the patient above say about this particular case and the overall experience of removing the bumpy AKN lesion through surgery.
More Dr. U Before and After Photos Showing Surgical Removal of Bump at the Back of Head
The following photos show other manifestations of fused AKN lesions and how they were removed through surgical excision, followed by staged wound closure. In both cases, the wound resolved into an inconspicuous linear scar.
With a small lump on the back of the head, the surgical cure to AKN with Dr. U was highly successful, resulting in a discrete linear scar at the base of the neck.*
What is the Cost of AKN Surgery?
When a patient asks, “What is the cost of AKN surgery?” there is no simple or direct answer at Dr.U Skin Clinic. This is because surgery differs from case to case, depending on the severity of the condition. A patient may have several small bumps or one tumescent raised bump on the back of the head requiring surgery. Additionally, supplementary treatments like laser therapy or steroid injections may be required for some and not others. Dr. Umar customizes every treatment plan to the unique patient’s needs and goals. For patients dealing with financial hardship, AKN removal surgery is not inaccessible. Dr.U Skin Clinic offers financing options and two levels of discounted pricing. Inquire about the cost and payment during your free consultation.
Frequently Asked Questions – Acne Keloidalis Nuchae Removal Surgery
Does health insurance cover the cost of an Acne Keloidalis Nuchae, a large or small lump on the back of the head needing a surgical cure?
Health insurance will generally not cover the cost of any procedure deemed cosmetic and not associated with a threat to the patient’s health. However, the nature of each case varies, and certain exceptions may be considered in some circumstances. Furthermore, not all AKN surgery clinics and service providers will accept payment through health insurance.
Do I need an AKN surgical removal of the bump at the back of my head? Can I choose natural treatments, medicine, or laser instead?
Not all patients need to get rid of bumps on the back of the head through surgery. In some cases, if caught early enough, the disease is manageable through topical and injectable medicines and laser treatments. There is no known form of natural treatment that has been shown to improve the signs of AKN.
In later stages, when the lesions have progressed to a tumescent mass or keloidal plaques, the disease will no longer respond to non-surgical remedies. Medication can provide relief from itchiness or discharge, but only temporarily.
Will any dermatologist’s office offer to remove an Acne Keloidalis Nuchae raised bump on the back of the head by surgery?
No, not all dermatologists offer Acne Keloidalis Nuchae removal surgery. Though relatively common, it remains an elusive condition that some dermatologists have difficulty identifying and diagnosing. Before choosing a doctor, please do plenty of research and be sure they specialize in AKN treatment, with a high level of patient satisfaction and a portfolio of positive outcomes.
For additional information on AKN and any other abnormal skin condition you may be experiencing, you can click the button below to access our Ask Dr. U online form:
Further Reading – Acne Keloidalis Nuchae Removal SurgeryReading – Acne Keloidalis Nuchae Removal Surgery
To learn more about acne keloidalis nuchae, visit our page on the causes and development of the condition.
Visit this article to learn more about managing AKN with drug-based therapies.
References
- Umar S, Khanna R. Papular acne keloidalis nuchae treatment success using follicular unit excision. JAAD Case Rep. 2023;39:96-100. Published 2023 Jul 25. doi:10.1016/j.jdcr.2023.07.013
- Tetracycline – Wikipedia. En.wikipedia.org. https://en.wikipedia.org/wiki/Tetracycline. Published 2022. Accessed August 2, 2022.
- Umar S, Castillo J, David C, Sandhu S. Patient selection criteria and innovative techniques for improving outcome and cosmesis in acne keloidalis nuchae lesion excision and primary closure.
- Wound Care Principles: Three Types of Wound Closure. WoundSource. https://www.woundsource.com/blog/wound-care-principles-three-types-wound-closure. Published 2022. Accessed August 2, 2022.
