Acne Keloidalis Nuchae and Targeted UVB Treatment

GA Okoye, BM Rainer, SG Leung, HS Suh, JH Kim, AM Nelson, LA Garza, AL Chien, S Kang


Acne keloidalis nuchae (AKN) is a chronic scarring folliculitis with fibrotic papules on the occipital scalp. Its treatment is limited and unsatisfactory.

To determine if targeted ultraviolet B (tUVB) phototherapy will (1) improve the clinical appearance of AKN and (2) induce extracellular matrix remodeling in affected lesions.

Eleven patients with AKN were enrolled in a prospective, randomized, split-scalp comparison study. One randomly selected side of the scalp was treated with tUVB up to three times weekly for eight weeks. After week 8, both sides were treated for eight additional weeks. Assessment included lesion counts in two 3x3 cm regions of interest (ROI), one on each side of the scalp (ROI-1: tUVB week 0-16, ROI-2: tUVB week 9-16), patient self-assessment, and analysis of MMP-1, MMP-9, TGF-β1, and Col1a1 mRNA expression by qRT-PCR.

Before treatment, the mean lesion count was similar between tUVB-treated and untreated sides (14.8 vs. 15.0). After eight weeks of tUVB, the mean lesion count decreased significantly to 9.4±1.2 (P=0.03), with no change on the untreated side. With continued treatment, the mean lesion count in ROI-1 decreased further to 7±1.5 (P=0.04) after 16 weeks of tUVB.

Targeted UVB significantly improved clinical appearance of AKN, led to patient satisfaction, and was well tolerated.

GA Okoye, BM Rainer, SG Leung, HS Suh, JH Kim, AM Nelson, LA Garza, AL Chien, S Kang
Improving Acne Keloidalis Nuchae With Targeted Ultraviolet B Treatment: A Prospective, Randomized, Split-Scalp Comparison Study
Br J Dermatol 2014 May 27;[EPub Ahead of Print]