“Acne keloidalis nuchae in brothers”-our experience in successful surgical management of extensive lesions

Acne keloidalis nuchae (AKN) is a chronic, idiopathic, inflammatory condition most commonly occurring in young black males and represents nearly 0.45% of all dermatoses affecting black patients. The male to female ratio is 20:1.It is initially characterized as firm skin colored papules and pustules on the occipital region of the scalp and posterior aspect of the upper part of the neck. These lesions later coalesce and may ultimately develop into tumor-like masses giving the appearance of keloidal plaques with destruction of hair follicles and loss of hair. Intracutaneous abscesses and sinus tracts with purulent discharge appear in advanced cases. While the pathogenesis remains uncertain, precipitating factors include localized trauma, chronic irritation, seborrhea, and androgen excess. In this article we review our experiences in two patients with extensive lesions who are brothers in the same family and discuss the advantages of management by electrosurgical excision followed by primary skin grafting.