Patient Story 03

Procedure performed by Dr. Girish Munavalli (Charlotte, North Carolina, USA)

Patient Description

A 30-year-old African American male had been suffering from acne keloidalis nuchae (AKN) in the occipital area of the scalp and posterior neck which had resulted in severe scarring in the affected area. Patient had severe itching and pain and the scars made the patient self-conscious and inhibited to the extent that that he did not want to leave the house and no longer took place in sporting events or gatherings with friends.

Treatment Performed

We performed Co2 laser on this patient. The keloidal tissue was electrosurgically excised following which the wound was allowed to heal via secondary intention, along with occlusive dressings and stringent wound care.

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Treatment Outcome

The patient’s condition was assessed 12 months after the procedure. The keloids showed no recurrence. The patient was relieved of the recurring distress of the painful nodules, even though the scar had some pigmentary alteration.


AKN is not uncommon amongst African American men and is exacerbated by cropping hairs too short in that area. The inflammatory reaction due to the ingrowing hair is called folliculitis, and this results in chronic hypertrophic and keloidal scarring. 

AKN is a frustrating and recurrent condition both for patients as well as their treating dermatologists and a permanent solution is difficult with oral medications or topical applications. Electrosurgical excision in our patient provided a very satisfactory outcome.