Tumor Stage Acne Keloidalis Nuchae Treated with Surgical Excision and Secondary Intention Healing

April 2012 | Volume 11 | Issue 4 | Features | 540 | Copyright © April 2012



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
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