What is the initial treatment for acne keloidalis nuchae (AKN) treated?

Updated: Nov 13, 2020
  • Author: Elizabeth K Satter, MD, MPH; Chief Editor: William D James, MD  more...
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The first step in management is education, which is key to preventing disease progression. Patients need to be made aware that the condition is exacerbated by short haircuts and close shaving. In addition, tight-fitting collared shirts, athletic head gear, and self-manipulation should be avoided since they may lead to mechanical shearing of the hairs.

Initiating therapy as quickly as possible after the initial appearance of lesions decreases the chance of long-term cosmetic disfigurement. [15] Topical antimicrobial cleaners/shampoos such as gentle foaming benzoyl peroxide washes or chlorhexidine can help prevent secondary infection. [11] Tar shampoos may provide an effective alternative. In addition, mild keratolytic agents containing alpha-hydroxy acids or topical retinoids may help soften the coarse hairs. Patients should discontinue hair greases or pomades, which can interfere with hair growth. [16]

Early, mild papular disease may respond to potent or superpotent topical steroids with or without the use of topical retinoids. This latter combination seems to be somewhat more effective than superpotent topical steroids alone. [17]

When pus or serous drainage is present, a culture should be taken. The use of a topical antibiotic (such as clindamycin) twice-daily may be advantageous to treat any bacterial superinfection. If active folliculitis is present, oral antibiotics such as doxycycline or minocycline should be used for several weeks to gain control over the inflammation. If active folliculitis persists or progresses despite adequate therapy, perform tissue culture and treat accordingly.

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