Bumps on the back of the neck (acne keloidalis nuchae)

What it is

Acne keloidalis nuchae (AKN) causes itchy, firm bumps and pustules on the back of the neck and lower scalp. Over time bumps can join into raised, keloid-like scars with hair loss.

How it works

Acne keloidalis nuchae starts as inflamed bumps around hair follicles at the back of the neck, where short curly hairs are cut very close. Ongoing inflammation leads to firm, scar-like bumps that can merge into keloid plaques.

Why it matters on darker skin

AKN mostly affects men of African descent who have close haircuts. Friction from shirt collars and helmets, and ingrown hairs, contribute.

Causes and triggers

Close haircuts and line-ups, tight collars, helmets, friction and scratching. Commoner in men of African descent.

What helps — and why it works

See a doctor early: anti-inflammatory creams and medicines can calm it and prevent scarring. Avoid very close shaves of the neckline; ask your barber to leave length at the nape. Use clean clippers and avoid tight collars. Avoid very close cuts at the nape: reduces ingrowth and inflammation. Expected timeline: new bumps reduce in weeks. Doctor treatment: steroid creams or injections, antibiotics, or laser for advanced disease. Expected timeline: months.

What to avoid and why

Avoid picking bumps, razor lining of the neckline, and sharing unsterilised clippers.

Common mistakes

• Shaving the nape with a razor.
• Picking bumps.
• Waiting until large plaques form.

Handling textured hair gently

Coily and curly hair is naturally the most fragile hair type because each bend in the strand is a weak point and natural oils travel down it slowly. That makes handling — how often and how firmly hair is combed, styled and pulled — as important as which products you buy. Detangle only when hair is wet and coated in conditioner, working in sections from the ends towards the roots with fingers or a wide-tooth comb. Keep heat to the lowest effective setting and always use a heat protectant. Sleep on satin or silk, or wear a satin bonnet, to reduce friction. Between wash days, a water-based leave-in followed by a light oil or cream helps hold moisture. Give the scalp attention too: it is skin, and needs regular cleansing, especially under wigs, weaves and braids, to prevent build-up, itch and infection. Any style that hurts, causes bumps or leaves the scalp tender is too tight and should be loosened. Hair grows about one centimetre a month, so changes in care take two to three months to show in length and thickness.

Scalp health and product choice

Choose a shampoo that suits the scalp and a conditioner that suits the lengths: the scalp may need cleansing or a medicated shampoo while the ends need moisture. Fragrance, essential oils and heavy waxes can irritate a sensitive scalp or cause build-up, and heavy oils on the scalp may worsen dandruff. Look for a clear ingredient list and a NAFDAC number, and patch-test new dyes and relaxers 48 hours before every use. Products that promise dramatic growth are usually untested; the treatments with the best evidence for pattern hair loss are medicines such as minoxidil, which should be started only after speaking to a pharmacist or doctor. Signs that you need medical advice rather than a new product include patches of hair loss, scarring or shiny skin, pain, pus, or shedding that continues for more than six months.

Questions to ask your doctor or pharmacist

Useful questions include: What do you think is causing this? Is it likely to come back, and how can I prevent it? Which products should I stop? How long before I should expect improvement, and when should I come back if it isn't better? Are there side effects to watch for? Is this treatment safe if I am pregnant, breastfeeding or for my child? Writing your questions down, bringing your products (or photos of their labels) and taking dated photos of the problem make an appointment much more useful.