Last Updated on June 9, 2021 by Dr Sanusi Umar MD
Acne keloidalis nuchae is an embarrassing, itchy, and painful type of folliculitis that forms on the rear scalp, almost exclusively in young men. When the disorder first appears, it is often mistaken for a persistent razor rash, and many people try to use natural home remedies or easy-access over-the-counter medications. However, these individuals soon find that these remedies fail when the condition has progressed despite their best efforts. Even a visit to the dermatologist for an antibiotic or steroid prescription will only help manage the disease at best. Drug treatments do not offer a cure. Acne keloidalis nuchae removal surgery is the only known method for permanently eradicating the bumps, lesions, and plaques that proliferate due to the condition. Waiting too long to seek medical attention for this disease typically creates more pain and discomfort, both physically and emotionally. The surgical removal of a bump at the back of the head may seem like an extreme measure. But it leads to immense long-term satisfaction.
Those wondering, “what is the cost of AKN surgery?” must really ask the question: what is the cost of NOT pursuing AKN excision? In most cases, the patient’s mental and emotional health, feelings of physical freedom, and restored self-confidence are priceless –and well worth the financial investment. Clinics who specialize in removing AKN will often offer financing and discount options to serve patients best, helping to make these procedures more accessible.
Dr. U’s years of study, research, and practice make him a top specialist for AKN removal using surgery as well as laser treatments.
For more information about this case, please visit: https://dru.com/acne-keloidalis-nuchae/surgical-treatment-of-akn-bumps-in-los-angeles-patient/ To consult…
When Should Acne Keloidalis Nuchae Removal Surgery Be Considered?
The classification diagram below displays the types of AKN as identified by Dr. Umar himself. AKN removal surgery is the most effective course of action when the papules and nodules merge into a single tissue mass. At this point, management with medications and even laser therapy becomes futile. Containment and temporary remission become highly unlikely as the pain, inflammation, size, and severity of the disease worsen.
At What Point is a Bump on Back of Head too Large for Surgery?
The following diagram below displays the different ways that AKN bumps can be distributed on the scalp, as identified by Dr. U. AKN removal surgery cannot be performed in stages IV. Using his “Batman” technique, Dr. Umar can align the surgical scar with the posterior hairline when the disease has not spread above or below the occiput line pass-thru and nape hairline pass-thru. If you notice the condition rapidly spreading or a growing raised merged bumps and lumps or masses on the back of the head, surgery should be considered. Consult a dermatologist as soon as possible.
Stages I or II bumps on the back of the head best for surgery. For a single large bump on the back of the head, surgical removal is still possible.
How to Get Rid of Bumps on the Back of the Head by Surgery: Traditional Methods
Here is a concise explanation for those wondering how AKN can be resolved by surgery at a standard clinic. The excision must be deep enough to remove all inflamed follicles causing the disorder. Once the base of the keloidal tissue is exhumed, long-term remission can realistically be expected. Whether it’s someone with a small lump on the back of the head seeking a surgical cure or someone with a large bump on the back of the head wanting surgical removal, the typical methods for AKN excision include:
- Excision with primary closure
- A combined approach of excision and grafting
- Staged excision using primary closure
- Electrosurgical excision
AKN Removal Surgery with Primary Closure
AKN removal surgery with primary closure is a technique wherein the surgeon cuts out the tissue in an elliptical shape, then immediately stitches the wound’s edges together. This is a good method for small narrow lesions. Wider lesions treated this way would result in wider stretched scars.
JAAD (Journal of the American Academy of Dermatology) published an article by Dr.U entitled, Patient selection criteria and innovative techniques for improving outcome and cosmesis in acne keloidalis nuchae lesion excision and primary closure. Patient cases that qualify for primary closure include AKN lesions less than 2.5cm in vertical width and located in the upper nuchal region. In this publication, Dr.U discusses his innovative technique, which involves Trichophytic excision and closure, a method that originated from strip surgery hair transplantation. Within the context of AKN, this approach involves cutting the upper wound edge at a specific angle. Secondly, the lower wound margin is cut to include decapitated hair follicles. Finally, the upper wound edge is then positioned to superimpose the bottom margin so that hair grows through, covering the resulting thin linear scar.
Patient selection criteria and innovative techniques for improving outcome and cosmesis in acne keloidalis nuchae lesion excision and primary closure
AKN Excision and Skin Grafting
Excision and grafting is an acne keloidalis nuchae removal surgery method proposed only in theory, not in actual practice. A skin graft would be used to close the wound after the excision. However, this results in a major mismatch of skin on the rear scalp. Also, the large bald grafted skin is not an aesthetically pleasing result. In 2011, Beckett, Lawson, and Cohen et al. noted that the grafted skin appears cosmetically subpar, as it does not blend with the surrounding skin. Dr. U does not subscribe to this type of surgery.
AKN Staged Excision Using Primary Closure
With staged AKN removal surgery using primary closure, the surgeon removes part of the lesion each time closing it primarily. This is then allowed to heal, after which another chunk of the remaining lesion is removed and closed primarily again. This continues until the lesion is removed, or it is no longer possible to continue due to lack of scalp laxity.
Acne Keloidalis Nuchae Excision with Second Intention Healing
In this approach, the AKN lesion is excised, and the wound is left open to heal on its own. According to Paul Kelly et al., if the posterior hairline is included and the excision is done beyond the depth of the hair follicles, they would contract on their own with an aesthetically pleasing linear scar that forms the boundary of a new posterior hairline.
[and led him to develop his “Batman” technique. This highly specialized excision method be used in combination surgically removes the bump on the back of the head to leave a normal-looking (straight or downward curved) posterior hairline (as opposed to one that is upwardly curved). Surgery can achieve the best patient outcome. Again, the objective is to remove the AKN tissue and leave cosmetically insignificant scarring along with a natural-looking hairline along the nape. As a result of these efforts, the patient can feel confident again]
Acne Keloidalis Nuchae – AKN: The Dr. U Approach
Dr.U has an approach to AKN surgery that is customized according to the presentation of the patient:
- Patients with narrow lesions are treated by excision and primary closure using trichophytic closure, with or without the aid of tension sutures.
- Patients with wider lesions (Stages I, II, and III), He adopts the approach of Excision Using the “Bat excision” he invented to direct a wound that closes with a straight or a downward curved posterior hairline as well as the use of tension sutures.
A Combined Approach to Acne Keloidalis Nuchae Removal Surgery at Dr.U Skin Clinic
Dr. Umar believes that a combined approach to surgical removal of a bump at the back of the head enables the most effective long-term cure. A strategy is determined based on the differing nature of patient needs. All people have varying medical histories, genetic backgrounds, and cosmetic ideals, in addition to the unique way AKN has presented on their scalp. Some patients may want the bump on the back of the head removed in surgery with little need for cosmetic satisfaction. And some patients require a visually normal-looking scalp with inconspicuous scarring and hair loss. Regardless, Dr. U’s outcome-based approach prioritizes the final aesthetic as much as possible, as this also has a long-term impact on the patient’s mental and emotional well-being.
Because Dr. U has seen so many non-surgical (and surgical) methods fail, he is a strong proponent of using his “Batman” excision technique along with other known therapies or medicines that assist the removal, cosmetic results, and healing process. For many, he has discovered how to get rid of bumps on the back of the head through surgery alone. But some patient cases may require a combination of treatments which may also include:
- Laser treatment
- Steroid injections
- Topical steroids
- Topical retinoids
Dr. U discusses and maps out the best plan of action for their individual needs and cost considerations with each of his patients. Contact Dr.U Skin Clinic for a free consultation on acne keloidalis nuchae removal surgery.
Expectations After Acne Keloidalis Nuchae Removal Surgery at Dr.U Skin Clinic
AKN patients should anticipate up to 2 months of downtime after their procedure. Wounds left to close by the second intention may require about 6-10 weeks for the wound to close post-surgery. Those who’ve removed a big bump on the back of the head through surgery may take longer than those who have addressed a small lump on the back of the head through their operation.
In either case, patients are asked to rest, limit the motion of their head and neck and follow any other recommendations or care instructions provided by Dr. U.
After the healing process has been completed, patients may notice their scar thin, flatten, and normalize in color over time. For many, the scar that results from the procedure is insignificant compared to the prior condition of painful lumps and bumps on the back of the head.
Patients with concerns before their procedure, such as “What is the cost of AKN surgery?” tend to value the improved quality of life after surgery. With the condition effectively treated, patients can enjoy no longer hiding under hats or long hairstyles.
Acne Keloidalis Nuchae – AKN Surgery: Examples From Dr. U AKN Clinic
Photo: Patient Who Regained Freedom After Acne Keloidalis Nuchae Removal Surgery
This patient suffered from AKN for nearly 10 years. It started as small, pimple-like bumps, which he treated with acne medications and washes. As the condition worsened, he sought the care of a dermatologist, who prescribed him an oral tetracycline. The condition continued to worsen until the bumps formed into a large mass gradually. He experienced pain, itching, and discharge of pus daily. Getting rid of the large bump on the back of his head by surgical removal proved highly successful with only five months post-surgery, and the patient is thrilled with the results.
In his words, the life-changing difference is, “Taking my kids to the beach. Going swimming in a swimming pool. Letting people see me without having to hide. Wearing a nice shirt and being able to expose the back of my head. I’ve got my freedom back.” Watch his video of the results below.
Video: Large Bump on Back of Head Surgical Removal at Dr. U AKN Clinic
Watch this video and listen to what Dr. Umar and the patient above have to say about this particular case and the overall experience of removing the bumpy AKN lesion through surgery.
More Dr. U Before and After Photos Showing Surgical Removal of Bump at the Back of Head
The following photos show other manifestations of fused AKN lesions and how they were removed through surgical excision, followed by staged wound closure. In both cases, the wound resolved into an inconspicuous linear scar.
What is the Cost of AKN Surgery?
When a patient asks, “What is the cost of AKN surgery?” there is no simple or direct answer at Dr.U Skin Clinic. This is because surgery is different from case to case, depending on the severity of your condition. You may have several small bumps or one tumescent raised bump on the back of the head requiring surgery. Additionally, supplementary treatments like laser therapy or steroid injections may be required for some and not others. Dr. Umar customizes every treatment plan to the unique patient needs and goals. For patients dealing with financial hardship, AKN removal surgery is not inaccessible. Dr.U Skin Clinic offers financing options, as well as two levels of discounted pricing. Inquire about cost and payment during your free consultation.
Frequently Asked Questions – Acne Keloidalis Nuchae Removal Surgery
Does health insurance cover the cost of an Acne Keloidalis Nuchae large or small lump on the back of the head needing a surgical cure?
Health insurance will generally not cover the cost of any procedure that might be deemed as cosmetic and not associated with a threat to the patient’s health. However, the nature of each case varies, and certain exceptions may be considered in scarce circumstances. Furthermore, not all AKN surgery clinics and service providers will accept payment through health insurance.
Do I absolutely need an AKN surgical removal of the bump at the back of my head? Can I choose natural treatments, medicine, or laser instead?
Not all patients need to get rid of bumps on the back of the head through surgery. In some cases, if caught early enough, the disease is manageable through topical and injectable medicines, as well as laser treatments. There is no known form of natural treatment that has been shown to improve the signs of AKN.
In later stages, when the lesions have progressed to a tumescent mass or keloidal plaques, the disease will no longer respond to non-surgical remedies. Medication can provide relief from itchiness or discharge, but only temporarily.
Will any dermatologist’s office offer to remove an Acne Keloidalis Nuchae raised bump on the back of the head by surgery?
No, not all dermatologists offer acne keloidalis nuchae removal surgery. Though fairly common, it remains an elusive condition that some dermatologists even have difficulty identifying and diagnosing. Before choosing a doctor, please do plenty of research and be sure he or she specializes in AKN treatment, with a high level of patient satisfaction and a portfolio of positive outcomes.
For additional information on AKN and any other abnormal skin condition you may be experiencing, you can click the button below to access our Ask Dr. U online form:
Further Reading – Acne Keloidalis Nuchae Removal Surgery
To learn more about acne keloidalis nuchae, visit our page on the causes and development of the condition.
Visit this article to learn more about managing AKN with drug-based therapies.