Acne Keloidalis Nuchae: A Staged Reconstruction

Acne keloidalis nuchae (AKN) is a chronic scarring folliculitis that affects the occipital area. It is characterized by papule and pustule formation which eventually leads to tumor-like mass. Early cases can be managed by medical treatment that may require months, and, usually, lesions recur. In more severe cases, surgical excision is the mainstay of treatment. In our case, we proposed a staged approach when dealing with advanced stages of AKN. This includes deep excision of the lesion down to deep subcutaneous tissue with application of negative-pressure wound therapy (NPWT) for a week followed by resurfacing of the resultant defect with a split-thickness skin graft and NPWT for another week. This approach achieved quicker wound healing with no recurrence compared with other techniques such as healing by secondary intention. To our knowledge, this case is one of the most extensive cases published in the literature.