Sore or itchy bumps at the back of the head may be more than shaving rash. If they keep returning, they can sometimes be a sign of acne keloidalis nuchae (AKN).
I am Dr Thuva, a dermatology doctor. In this guide, I explain why these bumps develop, how they can lead to scarring and which treatments may help.
In brief: Acne keloidalis nuchae is a long-term condition affecting hair follicles at the back of the scalp and neck. Early assessment and treatment may help reduce inflammation and limit further scarring or hair loss.
Tony’s Experience of Acne Keloidalis Treatment
Tony had been troubled by persistent raised areas at the back of his scalp for many months. They had proved stubborn and had not settled by themselves.
After examining his scalp, I discussed the likely diagnosis, what could aggravate it and the treatment options available. Tony chose a personalised plan that included three corticosteroid injection sessions.
At follow-up, most of the previously stubborn raised areas had become flatter and much less noticeable. I would describe this as a clear visible improvement rather than a cure. Tony’s response cannot predict how another person’s skin will respond, and further inflammation can still develop.
Before-and-after Acne Keloidalis Nuchae (AKN) Treatment
The back of Tony’s scalp before treatment and at follow-up after three treatment sessions. Most of the raised areas had visibly reduced. This is one person’s experience; results vary and cannot be guaranteed.
What Is Acne Keloidalis Nuchae (AKN)?
Acne keloidalis nuchae is an inflammatory condition affecting hair follicles around the nape of the neck and back of the scalp. It is also called acne keloidalis or folliculitis keloidalis.
Despite the name, it is not ordinary acne. The raised areas can look like keloid scars, but they are not usually true keloids. They develop after repeated inflammation damages the hair follicles and surrounding skin.
The condition is most common in men with Afro-textured or tightly curled hair, although it can affect people from other backgrounds. It is not contagious and is not simply caused by poor hygiene.
What Does Acne Keloidalis Look Like?
Early signs can include:
- Small, firm or itchy bumps at the back of the scalp.
- Spots or pustules around individual hairs.
- Tenderness, crusting or bleeding after a haircut.
- Ingrowing or tufted hairs.
- Darker marks following inflammation.
Without effective control, nearby bumps may join together and form thicker, raised areas. Established disease can lead to scarring and permanent hair loss in the affected skin.
What Causes Acne Keloidalis?
The exact cause is not fully understood. It appears to involve inflammation around the hair follicles, with several factors potentially contributing:
- Very short haircuts or close shaving.
- Ingrowing hairs.
- Coarse or tightly curled hair.
- Rubbing from tight collars, helmets or headwear.
- Scratching or picking the affected area.
- An individual’s immune and inflammatory response.
These factors do not affect everybody in the same way. Developing acne keloidalis does not mean that you have done anything wrong.
Which Acne Keloidalis Treatments May Help?
Treatment depends on whether the condition is active, how much skin is involved and whether thick scarring has developed.
Starting treatment earlier may make the inflammation easier to control and help protect nearby hair follicles.
Reduce Irritation
Simple changes can support medical treatment:
- Avoid razor shaving and very close clipping over the affected area.
- Leave slightly more hair at the back of the scalp.
- Reduce rubbing from collars, hats and helmets.
- Avoid picking, scratching or squeezing the bumps.
These steps may reduce irritation but cannot guarantee that the condition will stop progressing.
Prescription Scalp Treatment
Early or inflamed areas may be treated with prescribed anti-inflammatory scalp treatments. An antimicrobial treatment may also be considered when pustules or a secondary infection are present.
Some people with more active inflammation may need an oral antibiotic or another prescribed medicine. We recommend an individual medical consultation.
Corticosteroid Injections
For suitable raised or inflamed areas, small amounts of corticosteroid medicine can be placed into the affected skin. The aim is to reduce inflammation and help flatten the raised areas.
More than one session may be needed. Possible side effects include discomfort, skin-colour changes, visible small blood vessels and local thinning or denting of the skin. Improvement varies, and recurrence remains possible.
Extensive or Established Scarring
Large or thick areas may need our specialist assessment. Options can include laser procedures or surgery in selected cases. These treatments require a careful discussion about likely improvement, side effects and the possibility of recurrence.
Can Hair Grow Back?
Hair may continue to grow where the follicles have not been permanently damaged. Reducing active inflammation may help protect these remaining follicles.
Where established scarring has destroyed a follicle, hair regrowth is less likely. This is one reason why it is helpful to seek advice while bumps are still appearing or changing rather than waiting for a larger scarred area to form.
When Should You Seek Medical Advice?
Consider an assessment if:
- Bumps keep returning after haircuts.
- The area is painful, itchy, bleeding or discharging.
- Raised areas are becoming larger.
- Hair loss or scarring is spreading.
- Previous treatments have not helped.
Other scalp conditions can look similar, so getting the diagnosis right is an important first step.
Common Questions
Is Acne Keloidalis Contagious?
No. It cannot be passed from one person to another.
Can I Still Have Haircuts?
Yes. However, very close clipping or razor shaving may aggravate the area. Ask your barber to leave more length over the affected skin and ensure equipment is cleaned properly.
Can Acne Keloidalis Return After Treatment?
Yes. Treatment may improve the inflammation and raised areas, but the condition can return. Reducing irritation and attending follow-up can support longer-term control.
Concerned About Bumps or Scarring on Your Scalp?
If you have persistent bumps, inflammation or scarring at the back of your scalp, I can assess the area and discuss whether it may be acne keloidalis nuchae.
Where appropriate, I will explain the treatment options that may be suitable for you and how to reduce further irritation.
Book a dermatology consultation with me, Dr Thuva, at Dr.Derme Skin Clinic in Birmingham and Wimbledon.
✨ Book your consultation today at drderme.com/book
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