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Acne keloidalis nuchae: treatment with excision and second-intention healing.

BACKGROUND: Acne keloidalis nuchae (AKN) is a chronic inflammatory disorder of the posterior aspect of the neck and occipital region of the scalp. Despite numerous medical and surgical treatment modalities, few offer cure or a superior cosmetic result for patients with extensive disease.

OBJECTIVE: Our purpose was to determine whether excision with second-intention healing is an effective therapeutic modality for AKN.

METHODS: Excision of the involved area to the level of the muscle fascia or deep subcutaneous tissue was performed in six patients. Postoperative sites healed by second intention.

RESULTS: Four of six patients had a horizontal elliptic excision of the involved area that included the posterior hairline, with good to excellent results. The other two, who received nonelliptic excision of affected scalp that spared the hairline, had slower wound healing and poor contraction.

CONCLUSION: Best results were achieved in excision of AKN with second-intention healing when the excision was a horizontal ellipse of the posterior aspect of the scalp including the posterior hairline.

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