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Case Report Plastic and Aesthetic Research

Diode and Nd:YAG laser in a case of

refractory acne keloidalis nuchae

Ravi Kumar Chittoria, Devi Prasad Mohapatra, Friji Meethale Thiruvoth, Dinesh Kumar,
Arjun Asokan, Vijayaraghavan Nandhagopal

Department of Plastic Surgery, JIPMER, Gorimedu, Puducherry 605006, Tamil Nadu, India.
Address for correspondence: Dr. Arjun Asokan, Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and
Research, Gorimedu, Puducherry 605006, Tamil Nadu, India. E-mail: arjunashokan@gmail.com

ABSTRACT
Acne keloidalis nuchae (AKN) is a disease of unclear etiology that mainly affects males. Medical
treatment of AKN is difficult, with refractory cases often requiring ablation by laser or surgical resection.
We report herein, a 23-year-old male with refractory AKN treated successfully with combined laser
ablation, using an 810-nm diode laser and a 1064-nm Nd:YAG laser.

Key words:
Acne keloidalis nuchae, diode laser, Nd:YAG laser

INTRODUCTION CASE REPORT

The term acne keloidalis nuchae (AKN) was coined A 23‑year‑old male presented with multiple papules in the
[1]
in 1872 by Bazin. AKN is a condition characterized occipital scalp of 3 years duration. His main complaints
by follicular‑based papules and pustules that form were cosmetic disfigurement and difficulty in combing the
hypertrophic or keloid‑like scars. The principal sites are hair. He did not give a history of pruritus. On examination,
the occipital scalp and posterior neck. The condition multiple follicle‑based papules were observed over the
starts as mildly pruritic papules and pustules on the occipital scalp [Figure 1]. An incisional biopsy confirmed
occipital scalp or nape of the neck. This may subsequently the diagnosis of AKN. Histological examination showed
evolve to keloid‑like plaques. Later, abscesses and multiple skin with orthokeratosis and with increased pigmentation
sinus tracts may develop. Patients may also present with and periadnexal lymphocytic inflammatory infiltrate
cosmetic complaints with scarring alopecia in advanced [Figure 2].
cases. The condition has a male preponderance with a
male:female ratio of approximately 20:1. [2] He was initially treated by dermatologist with eight sittings
of intralesional triamcinolone acetonide injections at three
Treatment of AKN is difficult; numerous modalities have weekly intervals, subsequently followed by CO laser
2
been used with varying degrees of success. There is no delivery – 7 J/cm (2 sittings), 5.5 J/cm (1 sitting), and 9 J/cm
2
2
2
single definitive first‑line therapy. Early, mild papular disease (1 sitting) – with no significant improvement in the symptoms.
may respond to potent or superpotent topical steroids He was then referred to the Plastic Surgery Department for
(e.g., Clobetasol). Intralesional triamcinolone acetonide further management of the refractory lesions.
injection can be helpful to reduce the size and firmness of
papules and nodules. Refractory cases may respond to laser Since it was a case of refractory AKN, the patient was
ablation. taken up for alternate laser treatment. Two modalities
of lasers – the Nd:YAG (1064 nm) and the diode laser
Access this article online (810 nm) – were used as follows: the affected occipital
Quick Response Code: scalp was divided arbitrarily at the midline into two halves
Website: and one modality was administered in each half with the
www.parjournal.net
intent to find out the modality that had a better response,
which would be continued on both halves in subsequent
DOI: treatments. The right side of the occipital scalp was
10.4103/2347-9264.149380 treated with a diode laser (1 Hz/1 s/0.5 W) and the left
side was treated with a Nd:YAG laser (30 J/cm ) with a spot
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40 Plast Aesthet Res || Vol 2 || Issue 1 || Jan 15, 2015