Author Bio: Dr. Sanusi Umar MD is the author of this article.
Last Updated on November 17, 2020 by Dr Sanusi Umar MD
Acne Keloidalis Nuchae Non-Surgical Medical Treatment Services in Los Angeles: An acne keloidalis nuchae non-surgical medical treatment will use drugs to target the folliculitis that forms painful, itchy lumps and bumps on the back of the head and neck. These bumps can go untreated for a long time due to their initial similarity to a razor rash. For most patients the journey towards recovery begins with internet search terms like “How to get rid of bumps without surgery on the back of my head?” to which a myriad of confusing options are likely to pop up. Even primary care providers (PCPs) and some dermatologists can be perplexed by the simple question, “I have a bump on the back of my head, what is the medical treatment?”. Why, because it is a condition many health care providers are not familiar with.
At Dr.U Skin Clinic, Dr. Umar has successfully treated many patients suffering with this follicular ailment, both with and without surgery. Advanced conditions of acne keloidalis nuchae would often require surgical intervention. To have a good chance of a favorable response to non-surgical treatments, acne keloidalis nuchae must be treated at its earliest stages. Of the non-surgical treatment approaches, only laser treatment of acne keloidalis nuchae caries a chance at permanent cure. The use of medications would typically result in improvements in the physical appearance of the lesions and symptomatic relief, but the benefits are typically temporary and would recur with the complete withdrawal of treatment.
How Do I Know When to Seek Acne Keloidalis Nuchae Medical (Drug-Based) Treatment?
If you have any suspicion that you may be developing AKN, see a dermatologist immediately. The earlier the disease is caught, the better your treatment options for non-surgical removal. Knowing what acne keloidalis looks like from stage to stage is critical in identifying the condition. The use of drugs is likely to be recommended during the very early stages of the condition. Early, initial bumps may also be treated with laser, if their primary cause is ingrown hairs triggering the inflammation. However, advanced stages will not benefit from laser sessions or drug treatments. At this point, the large tissue masses from AKN can only be eliminated through surgical excision.
What Acne Keloidalis Nuchae Looks Like
The following signs and symptoms of AKN may present individually or in any combination:
- Pimple-like bumps on the rear scalp, typically at the nape area (though rare, these bumps can advance to cover the entire rear scalp)
- Larger bumps on the rear scalp that have begun to coalesce into a large, flat lesion
- Abnormal hair growth; tufts of hair clumping and growing between lesions
- Hairless, tumor-like formation, similar in appearance to a keloid
- Total hair loss in the affected area
- Discharge (i.e. blood or pus)
Photos of AKN Signs and Symptoms Early On
Both of the patients pictured below sought AKN treatment at Dr.U Skin Clinic early on. Dr. Umar was able to successfully treat both patients without having to perform surgical excision.
Stages of Acne Keloidalis Nuchae
Through years of research and study, Dr. Umar has developed his own classification system to index and identify the various manifestations of AKN. The disorder typically progresses in both severity of the lesions as well as their spatial distribution across the scalp. The specific type, as identified by Dr. Umar, is as follows, in correspondence with the diagram below:
- Papules: The bumps appearing on the back of the head each measure smaller than 1cm in diameter.
- Nodules: The bumps appearing on the back of the head each measure larger than 1cm in diameter.
- Merged Papules and Nodules: The bumps appearing on the back of the head are beginning to connect and coalesce.
- Keloidal Tumor/Mass: The bumps have fully coalesced into a tumescent mass, accompanied by hair loss in the infected area, or tufted hair growth at best.
- Flat Plaque: The keloidal tumor has become one large, flat, thick, and hairless site of infection.
The specific spatial distribution, as identified by Dr. Umar, is as follows, in correspondence with the diagram below:
- Stage I: The bumps appearing on the back of the head align centered between the occiput line pass thru and the neck hairline pass thu.
- Stage II: The bumps have multiplied and dispersed to cover the area between the occiput line pass thru and the neck hairline pass thru.
- Stage III: The bumps have multiplied and now extend from the neck hairline pass through to one or two inches beyond the occiput line pass thru.
- Stage IV: The bumps cover the entire rear scalp.
What Type/Stage is Best for Acne Keloidalis Nuchae Medication Based Treatment?
Ideally, when you begin to notice papules at stage one of distribution is the best time for non surgical treatment of acne keloidalis nuchae using medications. Once you are beyond the nodules stage and are beginning to notice a merging, it may be too late for effective relief from AKN without surgery. At this stage, medications only serve to keep the disease under control, minimize discomfort, and reduce inflammation.
Psychological Effects if AKN Non Surgical Treatment is Not Pursued
Aside from physical indicators, psychological wellness may also indicate when it is time to pursue AKN non surgical treatment. If your thoughts is dominated by “I have a bump on the back of my head, what is the medical treatment?” or find yourself becoming self conscious about it, seek help right away. Oftentimes, the road to resolving the disease is mentally and emotionally taxing, and becomes more so the longer you wait to seek help. Depression, self-consciousness, paranoia, and social withdrawal are common psychological symptoms for those who suffer with this scalp disorder, even at the earliest stage.
If you’re feeling even slightly self conscious about the lumps on the back of the head, do not delay getting medical advice.
Contact Dr.U Skin Clinic for a free consultation to find out how to get rid of bumps without surgery on the back of your head.
What Are the Options for Acne Keloidalis Nuchae Medical Treatment without Surgery?
If you’ve noticed the signs and symptoms early enough, there are a few options for non surgical acne keloidalis nuchae medical (drug-based) treatment, including the use of various medications. Many of these drug-based therapies, however, are temporary and unlikely to cure AKN. Their purpose is to keep the symptoms at bay for as long as they are used, limiting the associated pain, itching, and inflammation, and preventing the disease from progressing. If treatment is stopped, the condition will continue to progress, even if the lesions seemed to disappear or lessen while taking medication. Depending on exactly what stage you’re in, treatments can include:
- Antibiotics – topical and/or oral
- Retinoids – topical and/or oral
- Steroids – topical and/or injectable
- Laser therapy
Steroids are the main stay drug treatment of choice in acne keloidalis nuchae. It is used primarily for its anti-inflammatory effect and its ability to cause atrophy of the lesion. In AKN the inflammatory response to hair follicles is what causes the lumps to form. The persistent lumps and inflammation trigger a dysfunctional repair process, which then leads to a thickening of the skin and development of scar tissue. By treating the inflammation, steroids would be disrupting the disease at its origin. Steroids can be used topically or through direct injection into the lesions, a process called intralesional injection. Intra lesional injections of steroids are more effective than topical treatments.
Intralesional injections also help combat pain, itchiness and the discharge of pus. Lidocaine can be administered 2 hours prior to injection to numb any pain. The recommended steroids for AKN include:
- Clobetasol propionate
Antibiotics rarely help the condition itself, but alleviate drainage of pus and blood. If antibiotics are prescribed by your doctor, they should be applied or ingested for a full cycle lasting approximately 3 months. If drainage does not subside and abscesses persist, oral prednisone (a steroid) can be taken in conjunction with the course of antibiotics. The recommended antibiotics for AKN include:
Minocycline and Doxycycline are favoured becasue of their good coverage as well as their innate anti inflammatory properties.
Retinoids are typically prescribed when the disease is advancing rapidly. While the exact mechanism for its impact on AKN is not known, it is believed that retinoids will decrease inflammation of the infected tissue, slow oil production, and reduce bacteria (which also, in turn, helps with drainage). If you’ve been taking oral retinoids and decide to proceed with surgery, a washout period (stopping the medication) of 12 months is advised in order to prevent wound-healing complications.
Retinoids drastically shrink the skin’s oil glands by 35-58%, and curb oil production by about 80%. The bacteria that causes acne (P. acnes) live in skin oil. Therefore the drug would also help diminish the presence of bacteria associated with AKN which proliferates within the moist environment of the lesions. It also helps shed dead skin cells, which prevents the pores from clogging. The recommended retinoids for AKN include:
Photos of Acne Keloidalis Nuchae Medical Treatment with Steroids
When considering an approach to addressing a bump in back of the head, treatment creams containing steroids may seem like an acceptable non-surgical alternative. However, this drug-based treatment can come with several complications. The patient below presented to Dr.U Skin Clinic with small but noticeable AKN pustules on the back of his head. Dr. Umar treated him with high potency steroid creams and the lesions responded very well. Within two months they had shown significant improvement. However, after another two months, the remission cycle ended and the bumps returned. Steroid medications may treat symptoms of AKN such as inflammation, itchiness, and may even reduce the size of the lesion, but does not target the underlying cause of the condition. This patient is now considering laser therapy to remove the lesions.
Dr. U’s Analysis of What Causes Acne Keloidalis Nuchae
While the exact cause of AKN remains unknown, Dr. Umar believes that the condition typically begins with hair cut and irritation of the hair that culminates into ingrown hair. Next an inflammation is provoked that causes hypertrophic fibrotic response to cuase the keloidal lumps and pus. Dr Umar also believes that there is likely a hormonal basis for the disease. It almost exclusively occurs in males and is commonly a lot similar and often associated with another male hormone associated condition, acne vulgaris. This overall opinion is a result of Dr. Umar’s extensive research and experience in treating AKN patients using medication, lasers, ablative therapy, and also surgical excision.
If you would like to discuss your AKN treatment options with Dr. Umar, click the link below.
Frequently Asked Questions – Acne Keloidalis Nuchae Medical Treatment
I have a bump on the back of my head, what is the medical treatment?
An acne keloidalis medical, (drug based) treatment will be recommended by a doctor depending on the symptoms that are present. Antibiotics, for example may be prescribed if there is evidence of bacteria causing the production of pus. Signs of inflammation will be addressed using steroid injections. Smaller bumps may resolve to an extent, especially if they are in the very beginning stages of development. Once they evolve into larger masses of tissue, other forms of medical (non-drug based) treatment will be recommended, such as lasers and surgical excision.
Do you know how to get rid of bumps without surgery on back of head?
In the case of AKN, it is possible to get rid of bumps without surgery on the back of your head. The main factor used in determining if a non surgical course of treatment is useful is how early you catch the disease. The earlier you catch it the better, and the broader your treatment options. Early stage therapies include antibiotics, retinoids, steroids, and laser technology.
What is the best medical (drug based) treatment of acne keloidalis nuchae?
The best drug-based treatment of AKN would really depend on the nature of each individual case. Your dermatologist would be able to prescribe an appropriate medication depending on your symptoms. Medications offer the most promise at the very initial stages of AKN when there are very small bumps. Steroids are the mainstay of AKN drug based treatments. However drugs won’t typically cure the condition. In most cases, they help manage discomfort from symptoms like itching, pain, and drainage. And they can help reduce the swelling from inflammation that enlarges the AKN lesions. If medication is not effective and hair is triggering the inflammatory reactions, your doctor may recommend laser treatment for your condition.
At what point is it no longer possible to pursue AKN non surgical, medical (drug-based) treatment?
It is typically no longer beneficial to pursue AKN non surgical treatment when the disease has advanced to the keloidal tumor/mass and flat plaque stages. At this point surgical excision would be the best way to become free of the lesion. However, as each case is different, the only definitive answer can be found by consulting a dermatologist.
Are there any natural remedies for razor bumps on back of neck?
There are no known cases in which a natural remedy has proven to actually clear away AKN nodules or lesions. However, topical applications of natural products such as Aloe Vera or Witch Hazel may help with certain symptoms of the condition. Aloe Vera can soothe irritation caused by razor lumps on the nape of the neck, while Witch Hazel can somewhat reduce inflammation and redness.
To learn more about non-invasive AKN treatment, you can click the button below to send your questions to Dr. U himself:
See results of surgical AKN treatment here