AKN (Acne Keloidalis Nuchae) - Acne behind neck

Acne Keloidalis Nuchae literally means ‘scarring acne of the neck’. AKN is the result of inflammation in the follicle (referred as folliculitis). It is reported to be prevalent in African-Americans. However, it has been reported also in Hispanics and Asians. From dermatologists practising in India I understand that AKN is not too rare in India as well. It is believed that people with thick skin, thick hair or living in hot climates are more likely to get the disease. [1], [2]

In this skin disease, bumps appear on the back of the neck near or above the hairline. The problem starts with inflammation in the follicle wall, which results in its weakening. With weakening of the follicle, the hair shaft starts poking into surrounding skin tissues. This causes inflammation of the area surrounding the hair shaft and small acne-like eruption appears on the skin. The immune response to the inflammation, deposits fibrous connective tissue. This deposit is called fibrosis. The fibrosis is responsible for the dark bumps created over the follicle. The fibrosis obstructs the cavity for the hair shaft and this results in a perpetual inflammation and scarring around the follicle as the hair shaft continues to grow. [3]

The bumps are itchy & the condition aggravates with following actions: [4]

1. Regular rubbing of shirt collar (or helmet or cap) on the affected neck area
2. Close shave of the hair shafts in the affected neck area
3. Scratching of the affected neck area
4. Sweating & other conditions that aggravate inflammation

The root cause of this problem is inflammation and since these actions aggravate the skin inflammation, therefore they aggravate the problem. Also, it has been found that the inflammation creates cracks in the skin and often a secondary infection finds its way into the skin through the cracks. This leads to bacterial infection, in addition to the inflammatory condition. The bacteria responsible for the secondary infection is usually, Staphylococcus aureus. This bacteria is often found on human skin & it acts as an opportunist when it finds a crack in the skin. [4]

It is not known why mostly African-Americans suffer from AKN. The key trigger of the disease is also unknown. Anyway, let's focus on how to cure it. To cure the AKN, one has to follow a 4-pronged approach. First is to stop the actions that aggravate the inflammation. Second is to build a strong immunity. Third is to reduce inflammation on the skin. Fourth is to trigger autophagy of the body. [4], [5], [6]

Stop the actions that aggravate the inflammation

The actions that aggravate inflammation are listed above. Don’t wear a tight collar shirt, esp. with a tie. Avoid wearing a cap, a helmet or anything that presses/rubs on the affected area of the neck. Never shave hair at the affected area, nor clip them too short. Never scratch the affected area with your nails. (Bang your forehead with your fist if you have to, to suppress the urge to scratch.) Avoid sweating & exposing the affected area to direct heat. [4]

Also avoid those hair care products which can cause skin irritation. For details of such products refer to the article here.

Build a strong immunity

Strong immunity comes from a healthy liver. For a healthy liver, one has to take the following measures:

1. No refined white sugar
2. Not drinking water before & after meals
3. No snacking between meals
4. Properly chewing the food
5. No alcohol
6. No fruit juice
7. Good sleep at night
8. Regular exercise

These measures are the same as those for weight loss because obesity is just a symptom of a weak liver. One has to take care of the liver to strengthen immunity and weight correction happens automatically when you are successful in that. For details on these measures refer to the article here.

Reduce skin inflammation

Most of the measures required to reduce skin inflammation overlap with the measure for strong immunity. The additional one is to consume milk in the correct way. So, either don’t consume milk or strictly follow these guidelines:

1. Treat milk as a complete meal (Don’t drink milk with breakfast or any other meal)
2. Don’t eat anything 2 hrs before & 2 hrs after having milk
3. Consume milk in moderation (1 glass in a day)
4. Prefer Cow’s A2 milk
5. Don’t eat milk or cream with salt

These measures are the same as those explained in the article on curing the acne problem. For details on these guidelines refer to the article here.

Trigger autophagy of the body

Autophagy is a mechanism of the body that recycles its misfolded proteins. It is one of the capabilities of the human body that allows it to survive on unused resources available within the body, when it is short of supply from food intake. When used wisely, autophagy can help get rid of the ugly fibrosis deposits in the affected area.

To trigger autophagy one has to daily observe fasting for 14 hrs. Here, fasting refers to not eating anything during the period. One can consume only water during the period. This may not be as difficult as it may sound because the fasting can be done while you are sleeping. If you eat dinner at 8 PM and then have breakfast at 10 AM the next morning, then it is sufficient to trigger the autophagy. If you follow this routine for a few months, then the ugly scars of AKN will disappear automatically without any additional effort. [6]

Conclusion

It is still unknown why few people get this skin condition and others don’t. However, here we focus on what aggravates the condition if you have it, and how it can be cured. Emphasis of the cure is on not aggravating it further, strengthening immunity, reducing inflammation and utilizing autophagy.

There are few treatments which are often discussed for the cure of AKN, like applying topical creams, antibiotics, cryotherapy and laser treatment. One can refer to my blog here, to learn about my experiences with them and how the principles mentioned here helped me cure the disease. [3]

References

1. Maranda, E. L., Simmons, B. J., Nguyen, A. H., et al. (2016). Treatment of Acne Keloidalis Nuchae: A Systematic Review of the Literature. Dermatology and therapy, 6(3), 363–378. https://doi.org/10.1007/s13555-016-0134-5
2. Medigoo. Acne Keloidalis Nuchae. https://www.medigoo.com/articles/acne-keloidalis-nuchae/
3. Elizabeth K Satter, Philip R Letada. Acne Keloidalis Nuchae (AKN). Medscape. Nov 13, 2020. https://emedicine.medscape.com/article/1072149-overview , https://emedicine.medscape.com/article/1072149-treatment
4. Ogunbiyi A. Acne keloidalis nuchae: prevalence, impact, and management challenges. Clinical, Cosmetic and Investigational Dermatology. 2016;9:483–9. https://doi.org/10.2147/CCID.S99225
5. Kiyong Na, Sang Ho Oh, Sang Kyum Kim. Acne keloidalis nuchae in Asian: A single institutional experience. PLOS ONE 12(12): December 14, 2017. https://doi.org/10.1371/journal.pone.0189790
6. Ravanan P, Srikumar IF, Talwar P. Autophagy: The spotlight for cellular stress responses. Life Sciences. Nov 1, 2017;188:53-67. https://www.researchgate.net/publication/319438411_Autophagy_The_spotlight_for_cellular_stress_responses