Management of acne keloidalis nuchae

* The following clinical findings can be used to determine severity:

• Mild to moderate inflammation – Nonconfluent, small, inflammatory papules or pustules in the involved area.
• Moderate to severe inflammation – Numerous inflammatory lesions; extensive pustulation or suppuration; or large, inflammatory lesions.

¶ Topical corticosteroid therapy is often combined with topical antibacterial therapy and/or topical retinoid therapy in an attempt to augment the response to treatment. In our experience, inclusion of a topical antibacterial agent can be particularly helpful in patients with pustules. Examples of topical antimicrobials include clindamycin-benzoyl peroxide combination gel, erythromycin-benzoyl peroxide combination gel, benzoyl peroxide, and erythromycin.
Δ Re-evaluate every 4 to 6 weeks to assess for improvement and adverse effects of topical corticosteroids. Responses are usually evident within 6 to 8 weeks for topical corticosteroids, within 4 to 6 weeks for topical antimicrobial agents, and within 8 to 12 weeks for topical retinoids.