BH05 Acne keloidalis nuchae: addressing diagnostic and treatment gaps in a high-risk population

Abstract Acne keloidalis nuchae (AKN) is a primary cicatricial alopecia (PCA) characterized by chronic, scarring folliculitis. AKN is 20 times more prevalent in men than in women, with onset typically after adolescence, and is estimated to account for between 0.45% and 13.6% of all dermatoses in individuals of African descent (Maranda EL, Simmons BJ, Nguyen AH et al. Treatment of acne keloidalis nuchae: a systematic review of the literature. Dermatol Ther 2016; 6: 363–78). Although it primarily affects men of African descent with afro-textured hair, cases have also been reported in other ethnic groups. The condition usually affects the occipital scalp, leading to fibrotic scarring and permanent hair loss. This can be painful and disfiguring, significantly impacting patients’ mental health and quality of life. Despite its prevalence in high-risk populations, AKN remains under-recognized in dermatology, with no universal diagnostic criteria or treatment guidelines. This review synthesizes existing knowledge, highlights critical gaps and recommends future directions to improve early recognition and treatment strategies. A comprehensive literature review was conducted to explore pathophysiology, risk factors, diagnostic criteria and treatment modalities for AKN. A systematic search of PubMed, Scopus, Cochrane Library and Google Scholar was performed, including studies published between 2000 and 2025. Keywords included ‘acne keloidalis nuchae’, ‘scarring folliculitis’, ‘pathophysiology’, ‘treatment’ and ‘psychological impact’. The review included clinical trials, observational studies and case reports, while excluding non-English studies and articles without sufficient data on AKN. The pathophysiology of AKN is multifactorial, involving genetic predisposition, mechanical friction (e.g. from haircuts or helmets), hormonal influences and immune dysregulation. Treatment options for AKN include laser therapy, surgical interventions and medical therapies. Laser therapies, such as 1064-nm Nd:YAG and 810-nm diode lasers, have demonstrated 82–95% improvement in symptom reduction over one to five sessions (Maranda et al.). Surgical intervention, including excision and multimodal approaches, have shown 80–90% lesion reduction, although recurrence rates remain high (36%) (Madura C, Kareddy S, Kusuma MR, Chandrashekar BS. Multimodality surgical treatment approach to acne keloidalis nuchae based on lesion morphology. J Cutan Aesthet Surg 2021; 14: 256–9). Topical corticosteroids, antibiotics and retinoids provide symptomatic relief but often fall short in severe cases. The psychosocial impact of AKN is significant, with many patients experiencing embarrassment, anxiety and depression. Nevertheless, mental health support remains an underemphasized aspect of care. This review highlights the need for structured, evidence-based approaches to AKN diagnosis and management that consider both clinical and psychosocial factors. Future research should focus on genetic risk factors, optimizing combination therapies, and reducing recurrence rates by developing culturally competent treatment guidelines.