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What is AKN?

AKN is a condition characterized by follicular-based papules (small red bumps) and pustules (small red bumps with white pus at the tip) that form keloid-like scars if left untreated. This condition causes inflammation and swollen, painful hair follicles at the back of the scalp. 

According to review 2016, this condition is seen 20 times much more common in males than females, with coiled and coarse hair patterns, particularly seen in people with darker skin than people with lighter skin. 

How It Develops

Acne keloidalis nuchae develop when inflammatory cells go into your hair follicles on your neck, leading to damage of the follicle wall and the sebaceous or oil-secreting gland. This ruptures the follicle and kickstarts the inflammatory process. This eventually leads to the thickening and scarring of your skin tissue (fibrosis).

Causes

AKN usually begins after adolescence. The exact cause is not clear but according to research, this generally occurs due to inflammation of the head injury. These factors can also be a reason that causes this condition. This includes:

• Trauma
• Tighthead covering or shirt collars can cause friction and irritation that may contribute.
• Humidity can increase inflammation. 
• Androgen or male sex hormones are involved to produce this condition. 
• People with curly hairs more likely to develop AKN than people with other hair types.
• Sometimes infections caused due to hair tools used in barbershops. 
• People with seborrhea (A skin condition that occurs due to excessive discharge of sebum from the sebaceous gland) may also develop AKN.
• Molecular structures called antigens in the hair follicle can trigger inflammation, a condition known as autoinflammation. 
• Medicines like immunosuppressants e.g. cyclosporin and the epilepsy drugs like carbamazepine and phenytoin may cause AKN.

Symptoms

The first symptom of AKN is usually an itchy rash around the hair pores at the back of the scalp. 

Irritation usually occurs due to scratch or rubbing that particular area, which may turn into papules and pustules. 

AKL often starts with inflamed rashes called papules, which later develop into pustules. Over time, if not treated properly, it will lead to painful keloid scars. The papules fuse and form plaques and cover the broad area on the head side and become painful.

Treatment

A dermatologist will give the best advice based on the severity of the symptoms. The treatment may begin with over-the-counter products.

• Antibiotics: Topical or oral antibiotics, such as cefadroxil, clindamycin, doxycycline, erythromycin, and minocycline can be given. 
• Corticosteroids: These oral, topical, or injected drugs reduce inflammation. Examples include betamethasone, clobetasol, fluocinolone, and triamcinolone, and mometasone.
• Retinoids: These oral or topical drugs help to reduce inflammation and keep the pores unclogged. Examples include isotretinoin, acitretin, and tretinoin. 
• Skin cleansers that contain benzoyl peroxide or chlorhexidine may help to get rid of a bacterial infection, and tar shampoos may also be helpful.
• Laser and light therapy: These treatments destroy hair follicles and can improve the appearance of lesions. People may need several sessions to treat AKN. According to recent research, the use of laser therapy could decrease the size of lesions. 
• Surgery: Sometimes when these given options don’t work and severity is high, doctors suggest surgery.  

Prevention

The following preventive methods may be effective:

• Avoid close shaves and trims especially at the barber's shop. 
• The affected area should always be clean and dry to prevent infection
• Avoid wearing tight collars and headgear, to prevent irritation
• Avoid greasy hair products like hairsprays, gels, or pomades, which can interfere with hair growth.

At-Home Treatment

Apple cider vinegar- It has antibacterial properties, which fight bacteria and reduce the risk of infection. It can be used by diluting 1 tablespoon of apple cider vinegar with 3 tablespoons of water and then apply directly to the skin with a clean cotton pad.

Aloe vera-It is antibacterial and has many medicinal properties that fight bacteria and reduce inflammation. It can be applied directly with a clean cotton pad on the affected area. 

Tea tree oil-It has antiseptic and antibacterial properties that fight bacteria, reduce inflammation, and prevent infection. It can be used by diluting 1 tablespoon of tea tree oil with 3 tablespoons of water, they can apply directly to the skin with a clean cotton pad.

Summary

AKN is a chronic inflammatory condition that forms lesions at the back of the scalp and can lead to an itchy rash, pus-filled bumps, scars, and possibly hair loss. These are most common in males, with coarse or curl hairs with darker skin. 

Many treatments including medication and therapies are available that help to prevent its spread. If the options don’t work, it is advisable to seek medical attention as, if left untreated, will get severe and doctor advice for the surgery.