Acne Keloidalis

Those Painful, Scarring “Back-of-the-Neck” and Scalp Bumps

Acne keloidalis nuchae (deep pockets of inflammation buried under keloid scars), also called acne keloiditis (sore, pustular bumps) or AKN, affects the occipital scalp area, back of the neck, and in some cases, the entire scalp. This condition usually first appears and then flares up when black men get their hair cut close to the scalp with unsanitized clippers and trimmers. It is the most difficult-to-treat black skin care problem.

A painful and disfiguring scalp problem affecting mostly black men, it’s fueled by frequent low haircuts, failure to disinfect equipment, the rapid spread of bacteria, chronic inflammation and picking and scratching. Lesions frequently erupt, ooze and bleed during sleep and after showering. Left untreated, they often “morph” into raised scars that swell, throb, itch, spread, and cause permanent disfiguring scars and hair loss in the involved area.

Contaminated equipment and frequent haircuts in non-compliant barbershops, or by unlicensed roving neighborhood ‘barbers’ or jailhouse barbers, put men at a higher risk for AKN. It‘s not uncommon for contaminated clippers, trimmers, blades and attachments to have been used on tens of dozens of clients without being properly sanitized.

In the late 50s and 60s, most black men sported the low “quo vadis” hairstyle, and I can’t recall seeing a single case of AKN on any of my homeys back in the day. More recently, one of my longtime clients, a successful rapper/producer, relocated to the East Coast. He frequented two barbershops while he lived in Oakland and never suffered from AKN. Shortly after he moved, he got on a plane and came by to see me. Almost overnight, his smooth scalp had become unsightly and inflamed because his new barber failed to sanitize his equipment between clients.

Most short hairstyles, from the old school fades to the low, tapered and bald looks, require maintenance on a weekly or biweekly basis to look well-groomed. Frequent haircuts, bigger crowds in barbershops and busy barbers skipping the sanitation process between clients, helps spread the bacteria that causes AKN and the chronic inflammation that incites the development of permanent keloid scars.

AKN rarely occurs, or worsens if it exists, when folks (a) cut their own hair, sanitize religiously and don’t share clippers, (b) take their own equipment to the barbershop, or (c) go to a shop that is diligent about sanitizing. I’ve discovered, with very few exceptions, that barbers either have a low-to-non-existent incidence of AKN, or it occurs on a daily basis, spreading like wildfire to the shop’s clients. Either barbers sanitize thoroughly, or they don’t.

Traditional medicine provides either minimal relief or disappointing results in the vast majority of cases. Standard medical treatment includes (a.) oral antibiotics, systemic drugs used to treat a localized follicular disorder, (b.) retinoid creams, peeling agents that lack anti-bacterial and anti-inflammatory properties, (c.) a series of painful corticosteroid (Kenalog) injections into the bumps, designed to shrink scar tissue with often disappointing results, often worsening the condition, and (d.) scar revision surgery, designed to remove the entire involved area with a single incision, many if which become thick, protruding, cigar-shaped hypertrophic scars when   they heal.

As an inner-city skin care professional who has managed hundreds of AKN cases, I’ve helped countless men control, and sometimes even “erase” this preventable condition. During the initial consultation, I describe this scenario: “So, you go into the shop because you need a haircut or maybe just a quick taper and line. Several licensed barbers are buzzing away at a dozen scalps before one of them turns, looks directly at you and says: ‘Next!….I mean you, bra.’ And, after they call you to the chair, do you always witness a thorough sanitation of every clipper and liner blade and attachment before you get a haircut or a line? Well, do you?” This quick speech is usually met with stunned silence.

Exercise your rights. Insist that your barber follow standard sanitation procedures and disinfect combs, brushes and plastic clipper attachments in Barbicide and thoroughly spray clipper and trimmer blades, scissors, guards, metal attachments and even that little brush used to remove hair from clipper blades, between each and every client.

Early detection and appropriate treatment are crucial to the clearing process and will prevent scarring and hair loss. Try to compromise on that totally bald look for a while. Allow your hair to grow out a bit and wear that “low” style for a quick minute to speed up the healing process.

Important: Unhealthy lifestyle habits can aggravate AKN, including picking, scratching, rubbing with a towel and other forms of skin tampering, tight baseball caps, direct sun, obesity or being overweight, marijuana, extreme stress, lack of sleep, slacking up on corrective home care, and dietary iodides, including salt, milk, cheese, fast food, processed food, soups, sports drinks and salty snacks.

Follow prescribed home treatment exactly as directed, make important lifestyle changes, keep your weight in check, avoid direct sun, and stop all picking, rubbing and scratching. If you do, your mild-to-moderate case will improve dramatically. Even a severe case of AKN will begin to calm down and heal.

Professional treatments help exfoliate smaller bumps and soften, thin out and lighten scar tissue. Frequent follow-up visits, emails and phone calls allow us to evaluate your progress and product usage and monitor your lifestyle until clearing is achieved and maintained.

©2013 Kathryn Khadija Leverette

The material on this website is provided for educational purposes only, and is not to be used for medical advice, diagnosis or treatment.