Surgical management of acne keloidalis nuchae: A systematic review of outcomes and techniques

Background: Acne keloidalis nuchae (AKN) is a chronic inflammatory condition primarily affecting the nape, characterized by keloid-like papules and nodules that may progress to scarring alopecia. While AKN disproportionately affects individuals with coarse hair, especially African Americans, its surgical management remains poorly studied. This systematic review evaluates the outcomes of surgical treatment of AKN, including recurrence rates, complications, and patient satisfaction. Methods: A systematic review adhering to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines was conducted across four databases. Studies focusing on surgical interventions for AKN were included, with data extracted on demographics, surgical techniques, complications, and outcomes. Results: Sixteen studies comprising 99 patients met the inclusion criteria. AKN predominantly affected African American males (86.66%). Surgical techniques varied, with primary closure (58.16%) and secondary intention healing (28.42%) being the most common. Recurrence occurred in 19.19% of cases but was able to be managed conservatively. Hypertrophic scarring was noted in 11.43%, most commonly after primary closure. Infection rates were low (3.13%); however, topical and oral antibiotics were often part of postoperative treatment. Patient satisfaction and cosmetic outcomes were universally positive across studies, despite methodological variability. Conclusion: Surgical excision is an effective treatment for AKN. While recurrence still occurs, it can be managed conservatively. Additionally, hypertrophic scarring remains a challenge for patients with AKN. Infection rates were low, and high patient satisfaction was often reported. Standardized methodologies and multicenter studies are needed to optimize surgical approaches and long-term outcomes.