A Classic Presentation of Acne Keloidalis Nuchae in a Black Male

Acne keloidalis nuchae (AKN), also known as folliculitis keloidalis nuchae and nuchal keloid acne, is a chronic inflammatory skin disorder of the hair follicle. Predominantly occurring in the nuchal and occipital scalp, it can lead to keloid-like plaques and cicatricial alopecia. Primarily affecting people of color, more specifically African American individuals, it is associated with haircuts, friction, or trauma among a variety of other less common causes. The diagnosis is clinical with physical exam findings showing firm, dome-shaped papules or pustules, hypertrophic scars, inflammation, and alopecia. Although challenging as the disease progresses, management includes topical and systemic antimicrobials, corticosteroids, cryotherapy, laser therapy, and surgical excision. Early intervention is vital as it helps minimize the risk of permanent scarring and psychosocial impact. The following case report is about a young, African American male who presented to the outpatient clinic with findings concerning for AKN.