From the Department of Otolaryngology–Head and Neck Surgery (Dr Califano) and Department of Dermatology (Dr Miller), Johns Hopkins Hospital, Baltimore, Md; and the Division of Otolaryngology, Plastic and Reconstructive Surgery, University of New Mexico Health Sciences Center, Albuquerque (Dr Frodel).
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 × 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.
Califano J, Miller S, Frodel J. Treatment of Occipital Acne Keloidalis by Excision Followed by Secondary Intention Healing. Arch Facial Plast Surg. 1999;1(4):308-311. doi: