Acne Keloidalis Nuchae: Surgical Management with Electrosection and Second-Intention Healing

Introduction: Acne keloidalis nuchae is a frustrating disorder for both patient and physician when it is refractory to nonsurgical treatment options. Excision with adjuvant steroid injection is an accepted standard treatment for extensive or intractable lesions. However, surgical excision at this vascular anatomic region can be a tedious and bloody procedure. Repairs with grafting and flaps usually lead to less than satisfactory cosmetic results. We describe a surgical technique for refractory acne keloidalis nuchae that provides a clean and relatively bloodless surgical field and leaves the patient with cosmetically pleasing results. Materials and Methods: Nine patients with refractory occipital scalp and/or posterior neck acne keloidalis nuchae were treated with electrosection, using a blended cut and coagulation current on the Conmed Sabre 2400 electrosurgical unit. Healing was by second intention; no grafting or flaps were used. The surgical excision was followed by monthly postoperative intralesional triamcinolone acetonide (40 mg) injections for 3 months. Results: All 9 patients experienced excellent cosmetic results, and there was no evidence of recurrence during follow-up periods ranging from 2 to 21 months. Intraoperative bleeding was minimal, maintaining a clear operating field for the surgeon. Postoperative pain was controlled with acetaminophen alone or acetaminophen with codeine or hydrocodone. Conclusions: Electrosection with second-intention healing is a quick and effective technique for treating refractory acne keloidalis nuchae that yields excellent aesthetic results.