Table 2.
Surgical management of acne keloidalis nuchae
| Study | n | Sex, M:F | Mean age (range) | Previous treatment | Therapy | Specifications | Outcome | Side effects | Mean f/u (month) |
|---|---|---|---|---|---|---|---|---|---|
| Glenn et al. [4] | 6 | 6:0 | 33.3 (25–40) | Antibiotics (top./PO), steroids (top./IJ), retinoids (top./PO) | Surgical excision | Healing by second intention | Complete wound closure (n = 5, by 3 months). Good to excellent cosmetic results (n = 4). Mild recurrence (n = 2) | Postoperative bleeding (n = 2, resolved with ligature or pressure). Pain | – |
| Pestalardo et al. [31] | 1 | 1:0 | 40 | – | Tissue expansion | Expander (46 days), then local radiotherapy (weekly, total 1000 rad) | No recurrence at 2 years. Good cosmetic result | Infection (at 20 days, tx with cephalexin) | 24 |
| Califano et al. [28] | 5 | – | – | – | Surgical excision | Healing by second intention | Complete wound closure (n = 5, 6–10 weeks). Some hypertrophic scar formation | – | 2-48 |
| Gloster et al. [30] | 25 | 25:0 | 21–45 | Varied medical management | Surgical excision | Layered closure in 1 stage (n = 20), 2-stage excision with layered closure (n = 4), and excision with second-intention healing (n = 1) | Surgical scar usually hidden in new hairline. Patient subjectively rated success of surgery at average of 3.8 (1–4 scale). Small recurrent papules and hypertrophic scars (tx with steroids). No complete recurrence | No postoperative bleeding, infection, dehiscence or excess pain. Hypertrophic scars were excised resulting in moderate wound-edge tension | 12 |
| Bajaj et al. [26] | 2 | 2:0 | 43, 24 |
1. Clindamycin (top.), minocycline (PO) 2. Antibiotics (PO, top.), fluocinolone (top.) |
Surgical excision | Healing by second intention |
1. Granulation evident by 2 weeks, re-epithelialization by 8–10 weeks. Good cosmetic result and no recurrence at 14 months 2. Excellent healing in 3 months, no recurrence at 18 months |
No hypertrophic scarring | 14–18 |
| Verma et al. [32] | 4 | 3:1 | 35, 40, 31, 29 |
1. None 2. TAC (IJ) |
Surgical excision | – | 2. Lesion-free at 9 months | – | – |
| Beckett et al. [27] | 1 | 1:0 | 63 | Various topicals and corticosteroids (IJ) | Surgical excision | Electrosurgery blended mode, 20 W. Healing by second intention | Complete closure with only a small flat scar at 5 weeks. No recurrence at 8 months | – | 8 |
| Etzkorn et al. [29] (2012) | 1 | 1:0 | 44 | Steroids (IJ) | Surgical excision | Healing by second intention | Papules appeared at periphery of excision site at 5 weeks. Tx with doxycycline (100 mg bid ×30 days) and fluocinonide (top.). Complete resolution with patient satisfaction at 7 months | – | 7 |
| D’Souza et al. [34] | 1 | 1:0 | 38 | – | Dermabrasion | ×3 sessions | 50% reduction in size. Referred for surgical excision | – | – |
f/u follow-up, IJ injection, PO per os, TAC triamcinolone, top. topical, Tx treatment