Acne keloidalis nuchae (AKN): What’s the Best Treatment Option?
Acne keloidalis nuchae (AKN) is a chronic inflammatory condition that leads to significant scarring, alopecia and can negatively impact quality of life. The incidence of AKN is between 0.45% and 9%, and it primarily affects patients from darker skinned races and with curly or kinky hair. The condition is also more commonly found in men. The disease typically starts with formation of inflamed papules with marked redness, then over time continued inflammation leads to pronounced fibrosis and keloid formation with coalescence of the papules into large plaques and nodules. Later stages of presentation include chronic scarring and/or scarring alopecia without active inflammation.
The pathogenesis of AKN is not completely understood; there are several working theories which implicate skin injury and aberrant immune reactions as underlying causes. Other hypotheses suggest that afro-textured hair could play a role in inciting AKN, and some have proposed that AKN is due to an immune reaction. While the origins of AKN are still not determined, treatment is centered on slowing disease progression. If the disease reaches the later stages, surgical excision and skin grafting may be necessary, which requires long periods of healing. A recent study sought to explore the various medical, surgical and light therapies for AKN and discuss the clinical implications.
The authors concluded that for mild or moderate cases, medical management is the best option. Though they note that traditional medical management can require months of daily treatment and patients may relapse after discontinuation of treatment. Among the medical modalities, patients receiving intralesional steroids had the most dramatic improvement. Light and laser treatments show promise of offering a noninvasive and well-tolerated alternative. However, the research on the modalities is limited.
The authors caution that while surgical excision was extensively discussed in the literature, the option should be reserved for more extensive and refractory lesions. Surgical or cryosurgical treatment with secondary intention healing is the most effective treatment modality for AKN; however, the outcomes are still not optimal.
Byline: Martha L. Sikes, MS, RPh, PA-C
Posted: October 10, 2016
Source: Springer Link
Adapted from the original article.
[Image: DermNet New Zealand]