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Minimal dose radiotherapy for severe acne keloidalis nuchae?

A case report suggests that minimal dose radiotherapy may be an effective treatment for severe acne keloidalis nuchae (AKN) when other treatments such as medications, laser therapy or surgery are ineffective or contraindicated.

Published in the Journal of the American Academy of Dermatology, the case involved a 39-year-old Pacific-Asian-American male with AKN that covered nearly his entire scalp. Over the course of 14 years, he had failed conservative medical therapies. The patient was not a candidate for primary surgical intervention because of a history of diabetes, high blood pressure and obesity. He had also developed cutis verticis gyrata (CVG).

The author of the case report, Dr. Sanusi Umar, said he treated the patient with 20 radiotherapy sessions at 2 Gy per session at 6 MeV. The patient lost all of his hair within three days of treatment. Dr. Umar, a dermatologist and hair transplant specialist in Manhattan Beach, Calif., noted that hairs in the clinically less-inflamed inferior occipital CVG groove, where fibrotic AKN papules resided, as well as all non-disease areas (all remaining CVG folds), returned within five to six months. However, all hairs in the areas of clinically inflamed AKN plaques and masses were lost permanently, coinciding with permanent clearance of AKN lesions and gradual regression of tissue volume in all the affected areas of the scalp, including all the plaques and masses.

“Sixteen months after treatment, the patient is completely disease-free in the areas that responded, and the treated area continues to improve, as the very thick skin he had is returning closer to normal,” Dr. Umar wrote.


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