“Do big ugly bumps and scars reside on the back of your head?”

Acne Keloidalis, Scalp Bumps and Scars

What Are All Those “Back-of-the-Head” Bumps and Scars?

Acne keloidalis nuchae is characterized by deep pockets of inflammation buried under keloid scars. It’s sometimes referred to as AKN or acne keloiditis. It generally affects the back of the scalp and neck, and in some cases, the entire scalp. Chronic cases lead to hypertrophic and keloid scars and scarring hair loss called cicatricial alopecia. This condition usually first appears and flares up when black men get their hair cut close to the scalp with unsanitized clippers and liners.

A painful and disfiguring scalp problem, acne keloidalis nuchae is fueled by frequent haircuts, failure to disinfect equipment, the rapid spread of bacteria, and chronic inflammation. Lesions frequently erupt, ooze, and bleed during sleep and after showering. Left untreated, they often “morph” into raised scars that swell, throb, itch, spread, and cause permanent disfiguring keloids and hair loss in the involved area.


In the late 50s and 60s, many black men sported the low “quo vadis” hairstyle, and I can’t recall seeing a single case of acne keloidalis nuchae on any of my homies back in the day. More recently, one of my longtime clients, a successful rapper/producer, relocated to the East Coast. He frequented only two barbershops while he lived in Oakland and never suffered from AKN. Shortly after he moved, he was on a plane back to Oakland. Almost overnight, his smooth scalp became unsightly and inflamed because his new barber failed to sanitize his equipment between clients.

Most short hairstyles, including ‘old school’ fade haircuts, low tapered styles, and going completely bald, all require maintenance on a weekly or biweekly basis to look well-groomed. Frequent haircuts, bigger crowds in barbershops, and busy barbers skipping sanitation between clients, helps spread the bacteria that causes AKN and the chronic inflammation that incites the development of permanent keloid scars.

How Acne Keloidalis Nuchae Starts

Contaminated equipment and frequent haircuts in non-compliant barbershops, unlicensed roving neighborhood ‘barbers’, and jailhouse barbers put black men at a higher risk for acne keloidalis nuchae. It‘s not uncommon for barbers to use contaminated clippers, T-edgers, blades and attachments on tens of dozens of clients without sanitizing anything. The stiff brush most barbers use to remove loose hair from clippers and trimmers may never be sanitized.

Acne keloidalis nuchae rarely shows up or worsens when folks (a) cut their own hair, sanitize religiously and don’t share clippers, (b) take their own equipment to the barbershop, or (c) go to a shop that is diligent about sanitizing. I’ve discovered, with very few exceptions, that a barber either has a low-to-non-existent incidence of AKN, or it occurs on a daily basis. One barber can spread acne keloidalis like wildfire to most or all of his clients. Barbers either sanitize their equipment thoroughly, or they don’t.

Does Your Barber Sanitize?

As an inner-city skin care professional, I’ve helped countless men calm and control this preventable condition. During the initial consultation, I describe these scenarios: “You cheated on your regular barber, right?” or “So, you go to the shop for a fresh cut or maybe a quick line and taper. Several licensed barbers are buzzing away at a dozen scalps before one of them turns to you and says: ‘Next!….I mean you, bra.’ As you’re called to the chair, does your barber break out the disinfection spray and thoroughly sanitize every clipper, liner, guard, attachment and the little brush used to clean the blades before you get your haircut, taper or line? Well, does he?” My quick comments almost always met with stunned silence.

Exercise Your Rights

Go to licensed barbers. Insist they follow standard sanitation procedures and disinfect combs, brushes and plastic clipper attachments in Barbicide. Watch them use a disinfectant spray on all clipper, liner and trimmer blades, scissors, guards, metal attachments, and even that little brush used to remove hair from clipper blades, between each and every client. If they don’t, get up and walk out.

Acne Keloidalis Nuchae Is Linked to Lifestyle

Your lifestyle choices don’t cause AKN, but they can definitely aggravate it. Factors include shaving habits, picking, scratching, rubbing with a towel, and other forms of skin tampering, tight baseball caps, dirty clippers, direct sun, obesity or being overweight, using tobacco, smoking weed in blunts, extreme stress, lack of sleep, slacking up on your home care, eating peanuts which contain hormones, and dietary iodides, including salt, all dairy (milk, cheese, sour cream, yogurt, whipped cream, whey), fast food, processed food, soups, seaweed, sports drinks, and salty snacks.

Medical Treatments That Don’t Work

Traditional medicine provides either minimal relief or disappointing results in the vast majority of cases. Standard medical treatment includes (a.) oral antibiotics, systemic drugs used to treat a localized follicular disorder, (b.) retinoid creams, peeling agents that lack anti-bacterial and anti-inflammatory properties, (c.) a series of painful steroid injections into the bumps, designed to shrink scar tissue with often disappointing results, often worsening the condition, and (d.) scar revision surgery, designed to remove the entire involved area with a single incision, many of which become thick, protruding, cigar-shaped hypertrophic or keloid scars when they heal.

Our Treatment System

Early detection and appropriate treatment are crucial to the clearing process and will prevent scarring and hair loss. Clinically Clear® Skin Rehab Center’s treatment plan includes making specific lifestyle changes, getting periodic scar treatments, and using our highly-effective homecare products on a consistent basis. Keep your weight in check, avoid direct sun, pay close attention to barbershop sanitation, and call an immediate halt to picking, rubbing, and scratching. If you’re diligent, follow your regimen religiously, and lose weight if you need to, your mild-to-moderate case of AKN will improve dramatically. Even a severe case of AKN will begin to calm down.

A series of professional scar treatments help exfoliate smaller bumps and soften, reduce thickness, and lighten thick scar tissue. Frequent follow-up visits and/or emails and phone calls will allow us to evaluate and monitor your progress, lifestyle habits, and product usage so clearing can be achieved and maintained.

Note: Individual results may vary and require compliance with corrective home care products, diligent sun protection, professional treatments, and important lifestyle changes, all of which must be monitored and maintained on a long-term basis.

©2018 Kathryn Khadija Leverette and clinicallyclear.com. Reprinted with permission.

The material on this website is provided for educational purposes only and is not to be used for medical advice, diagnosis or treatment.