Case of the Month with Crutchfield Dermatology

Wednesday, August 28, 2019

A patient presented with a four-year history of pruritic bumps on the back of his head and neck.


At 12-week follow-up visit

Diagnosis: Acne Keloidalis Nuchae (AKN)

AKN is a very challenging condition to treat (and also somewhat tricky to capture results of in a photograph). The patient has had AKN for four-plus years. He reports that the papules are intensely pruritic. He has concomitant sebopsoriasis on the right side of his scalp.


My protocol for treating AKN is doxycycline 100mg capsules BID for six weeks, then 100 QD for six weeks. I also have patients apply betamethasone dipropionate ointment BID for six weeks and QD for six weeks. We had this patient use a clobetasol solution on the sebopsoriasis on the right side of his head, twice daily for two weeks, then pulse it, intermittently, on Wednesdays and Saturdays after that. He was delighted with all results.

For possible future flare-ups, we instructed him to repeat the doxycycline and betamethasone dipropionate ointment, as initially prescribed, for one month.

For more information, contact Charles E. Crutchfield III, MD, at Crutchfield Dermatology or visit