From the Guidelines
Intralesional corticosteroid injections with triamcinolone acetonide 10mg/mL are the most effective treatment for acne keloidalis nuchae, particularly for inflammatory follicular lesions. This treatment approach is supported by the guidelines of care for the management of acne vulgaris, which includes acne keloidalis as an indication for intralesional corticosteroid injections 1. The dosing for acne keloidalis is specified as triamcinolone acetonide 10mg/mL injected into inflammatory follicular lesions.
Some key points to consider when using intralesional corticosteroid injections for acne keloidalis nuchae include:
- Contraindications, such as active infections, previous hypersensitivity to triamcinolone, and certain systemic conditions like active tuberculosis or uncontrolled diabetes 1
- Short-term results, with most acne nodules flattening within 48 to 72 hours of injection 1
- Efficacy, with intralesional corticosteroid injections being efficacious for occasional or stubborn cystic lesions, but not as an effective treatment strategy for patients with multiple lesions 1
- Adverse effects, including local overdose, infections, impaired wound healing, and systemic effects like suppression of the hypothalamic-pituitary-adrenal axis 1
It is essential to weigh the benefits and risks of intralesional corticosteroid injections for acne keloidalis nuchae and to consider individual patient factors, such as the severity of the condition and the presence of any contraindications. However, based on the available evidence, intralesional corticosteroid injections with triamcinolone acetonide 10mg/mL remain the most effective treatment option for acne keloidalis nuchae 1.
From the Research
Treatment Options for Acne Keloidalis Nuchae
- Medical management: Traditional medical management focuses on prevention, utilization of oral and topical antibiotics, and intralesional steroids to decrease inflammation and secondary infections 2
- Light and laser therapies: Light and laser therapies offer an alternative treatment for AKN, with the 1064-nm neodymium-doped yttrium aluminum garnet laser, 810-nm diode laser, and CO2 laser showing 82-95% improvement in 1-5 sessions 2
- Surgical approach: Surgical excision with primary or secondary closure, split-thickness skin grafts, and laser-assisted treatments have been tried, but most surgical methods have longer downtime with a higher chance of relapse 3
- Multimodality surgical treatment: A multimodality surgical approach based on lesion morphology, including excision and primary closure, punch excision, and intralesional cryotherapy, can be effective in treating chronic AKN 4
- Combination therapy: Combining two conventionally available modalities, such as ablation with carbon dioxide laser and intralesional triamcinolone acetonide, can be an effective treatment option for AKN 3
- Electrosurgical excision: Electrosurgical excision with secondary intention healing can be a recommended option for patients with large plaque- and tumor-stage acne keloidalis nuchae 5
Key Considerations
- Early diagnosis and treatment are essential to reduce morbidity and preserve healing 6
- The choice of treatment depends on the clinical stage of the disease and the individual patient's needs 5
- A multifaceted approach involving combination therapies can be effective in some cases 5
- Surgical excision remains the most effective modality of management, but it may require general anesthesia and has a longer recovery time 4