Case of the Month

The patient presents with a 4-year history of pruritic bumps on the back of his head and neck.

Diagnosis: Acne Keloidalis Nuchae (AKN)

Acne Keloidalis Nuchae is a very challenging condition to treat (and also somewhat tricky to capture results in a photograph). The patient has had Acne Keloidalis Nuchae for 4+ years. He reports that the papules are intensely pruritic. He also has concomitant sebopsoriasis on the right side of his scalp. My protocol for treating AKN is Doxycycline 100mg capsules BID x 6 weeks, then 100 QD x 6 weeks. I also have them apply Diprolene ointment BID x 6 weeks and QD x 6 weeks. We had him use a clobetasol solution on the sebopsoriasis on the right side of his head, twice daily for 2 weeks then pulse it, intermittently, on Wednesdays and Saturdays after that. He was delighted with all results, and this is a photo at the 12-week follow-up visit. For possible future flare-ups, we instructed him to repeat the doxycycline and Diprolene ointment, as initially prescribed, for 1 month.

References

VisualDx: Acne Keloidalis Nuchae

Acne Keloidalis Nuchae A CLINICAL ATLAS OF 101 COMMON SKIN DISEASES With Histopathologic Correlation A. BERNARD ACKERMAN, HELMET KERL, JORGE SANCHEZ, YING GUO, ANGELIKA HOFER, PAUL KELLY, TETSU KIMURA, GIOVANNI BORRONI ,CHARLES CRUTCHFIELD, VOLKER STEINKRAUS, WOLFGANG WEYERS page 13.