Treatment of occipital acne keloidalis by excision followed by secondary intention healing.

OBJECTIVE: To demonstrate the principle of excision with healing by secondary intention in the treatment of occipital acne keloidalis, a chronic, inflammatory condition characterized by inflammation and hypertrophic scarring on the posterior aspect of the neck and the occipital aspect of the scalp.

SETTING: Academic teaching institution.

METHODS: Five consecutive patients with massive (> 10 x 15-cm) occipital keloids, all actively infected and growing, were treated by excision of the lesion deep to the dermis and hair follicles. Aggressive local wound care of the wound followed, with the end point being complete reepithelialization of the region.

RESULTS: Complete wound closure took place in all patients within 6 to 10 weeks. No complications or recurrences occurred. Cosmetic results were judged as fair to good. Follow-up ranged from 2 months to 4 years.

CONCLUSIONS: Successful treatment of occipital acne keloidalis with direct excision and secondary intention wound healing is demonstrated. While cosmetic results are not optimal, this form of treatment has produced stable scar beds without return of infection or keloids.