Electrosurgical excision of acne keloidalis nuchae with secondary intention healing

Abstract

Acne keloidalis nuchae is an idiopathic, scarring folliculitis characterized by the formation of papules and pustules that may ultimately develop into tumor-like masses distributed on the nape of the neck and occipital region of the scalp. This hyperproliferative disorder is most commonly seen in African-American men. While the pathogenesis remains uncertain, precipitating factors include localized trauma, chronic irritation, seborrhea, and androgen excess. The treatment of acne keloidalis nuchae is challenging and depends on the clinical stage of the disease; however, a multifaceted approach involving combination therapies has proven to be effective in some cases. Excision with healing by secondary intention is a recommended option for patients with large plaque- and tumor-stage acne keloidalis nuchae. This case report reviews the management of a patient with tumor-stage acne keloidalis nuchae successfully treated with electrosurgical excision and secondary intention healing with excellent cosmetic results and no recurrence of the disease.

Figure 1

Papulopustular stage of acne keloidalis nuchae

Figure 2

On physical exam, the patient had a 5x8cm keloidal mass on the occipital scalp representing the tumor stage of acne keloidalis nuchae. Reprinted with permission from J Drugs Dermatol. 2010;9(10):1249–1257.

Figure 3

Excision was performed in a horizontal fashion and to a depth beneath all keloidal tissue and tufted follicles. A clean base was the clinical endpoint. Reprinted with permission from J Drugs Dermatol. 2010;9(10):1249–1257.

Figure 4

One week following the procedure, the wound was healing well with adequate granulation tissue present at the base.

Figure 5

Five weeks after the procedure, the wound was virtually closed with good wound contraction and only a small flat scar. Reprinted with permission from J Drugs Dermatol. 2010;9(10):1249–1257.