The surgical management of extensive cases of acne keloidalis nuchae.

OBJECTIVE To determine the efficacy of excision with primary closure in the treatment of extensive and refractory acne keloidalis nuchae (AKN). DESIGN Intervention before-after trial. Duration of follow-up ranged from 1 to 5 years. SETTING University-based ambulatory outpatient dermatologic surgery unit. PATIENTS Referred sample of 25 patients with extensive AKN that was refractory to medical management. All patients were healthy, young black men who had no medical problems and were not taking any medications. No other eligible patients refused to be included in the study. All 25 patients completed the study. INTERVENTIONS All 25 patients underwent surgical excision of AKN. Twenty of the 25 underwent excision with layered closure in 1 stage. Four patients underwent 2-stage excisions with layered closure. One patient underwent excision with second-intention healing. MAIN OUTCOME MEASURE A test of the following hypothesis: excision with primary closure is a successful treatment modality with little risk of recurrence for extensive cases of AKN. RESULTS The author and all 25 patients rated the cosmetic result of surgery as good to excellent. No patients experienced complete recurrence of their acne keloids. Fifteen patients developed tiny pustules and papules within the surgical scar. Five patients developed hypertrophic scars. Papules, pustules, and hypertrophic scars were all successfully treated with high-potency topical and intralesional steroids. CONCLUSIONS Excision with primary closure is an excellent surgical treatment modality for the management of extensive cases of AKN. Extremely large lesions should be excised in multiple stages. The surgeon should carefully assess each patient to determine whether AKN should be excised in 1 or multiple stages.