Electrosurgical excision of acne keloidalis nuchae with secondary intention healing

Acne keloidalis nuchae is an idiopathic, scarring folliculitis characterized by the formation of papules and pustules that may ultimately develop into tumor-like masses distributed on the nape of the neck and occipital region of the scalp. This hyperproliferative disorder is most commonly seen in African-American men. While the pathogenesis remains uncertain, precipitating factors include localized trauma, chronic irritation, seborrhea, and androgen excess. The treatment of acne keloidalis nuchae is challenging and depends on the clinical stage of the disease; however, a multifaceted approach involving combination therapies has proven to be effective in some cases. Excision with healing by secondary intention is a recommended option for patients with large plaque- and tumor-stage acne keloidalis nuchae. This case report reviews the management of a patient with tumor-stage acne keloidalis nuchae successfully treated with electrosurgical excision and secondary intention healing with excellent cosmetic results and no recurrence of the disease.