An African-American male, aged 44 years, presented
with an enlarging, painful, and pruritic mass on his
scalp possibly triggered by a "close haircut." He had
failed to respond to intralesional corticosteroids. On examination, a multi-nodular, keloidal mass extended from the central
occipital scalp to the right temporal scalp (Figure 1, Figure 2).
After discussing treatment options with the patient, he was
scheduled for excision.
The site was cleansed and anesthetized via local anesthesia. The
keloidal tissue was excised. Care was taken to extend the depth
of the excision down to normal-appearing subcutaneous fat just
below the level any visible follicular structures. Bleeding was
cauterized. The wound was covered with petrolatum, followed
by Telfa non-stick pads, and then covered by sterile gauze.
Five weeks later, a few papules were noted peripherally at the
completely healed excision site; these papules were injected
with triamcinolone. The patient was given doxycycline 100 mg
to be taken twice daily for 30 days and fluocinonide ointment to
be applied twice daily to any raised papules.
Seven months after surgery, the patient noted complete sat-
isfaction with the outcome of the procedure. On physical
examination, a supple, slightly depressed patch was noted at
the excision site (Figure 3, Figure 4).
AKN is an idiopathic, scarring folliculitis of the occipital
scalp and nape of the neck that affects post-pubertal African-American men. Early lesions are often treated with topical or
intralesional corticosteroids and tetracycline class antibiotics.1 For large plaque and tumor stage AKN, surgical excision may
be the treatment of choice. Recurrences are more likely if the