Published on October 23, 2020. Last Updated on June 27, 2024.

Redditors share dozens upon dozens of pictures of their bumps. And in some instances, they call their bumps something other than what it is. Those bumps could be a number of things. But it could also be Acne Keloidalis Nuchae, AKN, a skin condition where bumps or papules and pustules fuse into mass bumps and lumps. 

According to Medscape, “the exact etiology of Acne Keloidalis Nuchae is unclear (3).” Therefore making it difficult to properly diagnose or treat. In Redditors’ defense, they could be misdiagnosed and not know they have AKN. Considering there is limited research, information, and treatment on AKN, it may be challenging to pinpoint the type of bumps on the back of the head or scalp.  Most healthcare providers have even told patients there’s no cure for their AKN.

This makes the bumps harder to treat. Worse of all, with improper treatment, they often come back with an ardent vengeance. In the same vein, people with bumps on the head struggle in silence and are often embarrassed by them. 

Not Acne Keloidalis Nuchae : Other Types of Bumps Found on the Back of the Head

Dr. Sanusi Umar, also known as Dr. Bumpinator pointed out that bumps on the skin are common and in some cases harmless. He explained that bumps result from a number of conditions with the appearance and type contingent upon the cause. They vary from acne, infections, allergic reactions, skin cancer, or skin disorders. 

Ultimately, when dealing, particularly with bumps on the scalp or back of the head, finding the exact type is tricky. So, what happens when your bumps aren’t the same as other Redditors and home remedies aren’t working? If the bumps on the back of the head persist or get worse – 

“Don’t self-diagnose,” Dr. Bumpinator said. “You could have a more serious condition and it may require special attention.” 

According to Dr. Bumpinator at Dr. U Hair and Skin Clinic in Manhattan Beach, Calif. –

“AKN is often associated with every other condition, but itself.“ 

Above all, AKN bumps, at first glance, are often confused for folliculitis more than other types of bumps.

1. The Folliculitis Debate

Living with these bumps in some instances, when trying to get a haircut, there are special requirements. For example, Reddit user, u/virgil_caine31/ said he’d been looking for a particular barber who wouldn’t get “weirded out” by his bumps.

“I’m looking for a barber who can accommodate my weird, if not embarrassing, situation. I have pretty bad folliculitis on my scalp and it gets especially bad in the summer. Basically it just causes red bumps and sometimes they scab and can bleed.” 

In other words, u/virgil_caine31/ alleges he has folliculitis, but his symptoms could also mirror Acne Keloidalis Nuchae, AKN. 

Unfortunately, it’s hard to tell which is which, unless an expert specialist diagnoses the bumps. Nevertheless, when folliculitis occurs the hair follicles are inflamed. This skin condition is sometimes a bacterial or fungal infection that has small red or white pimples at the follicles. Common and benign, it forms bumps on the back of the scalp in the form of a rash. However, folliculitis with few pustules will resolve spontaneously within a few days, according to research (6). 

Reddit user, /u/feedittothetree shared a picture of his small, but inflamed bumps and asked –

“Weird bumps on the back of my head. Anyone know [what]it is?” 

Underneath his question, /u/Sparxfly responded: 

“Probably folliculitis. That’s a common area for people to get it. You can try washing the area with an antibacterial soap and see if it helps. But otherwise a dermatologist would be the place to start. Usually it’s treated with antibiotics. Shaving the area can make it worse.” 

According to Dr Bumpinator, there are also non-infectious causes of folliculitis. For this reason, Dr. Bumpinator recommends seeing a dermatologist instead of trying to self-treat.

2. The Bulging Boils 

Concerned girlfriend, Danielle, u/daniellenicole18/, turned to Reddit for feedback on her boyfriend’s bumps  –

“So my boyfriend, 25, used to have really nice hair. In 2016, he started to get these like pus filled boil/pimple type things on his head. They would burst and bleed it wasn’t pretty. He started losing hair where they would grow.”

By 2017-18, she said, he was prescribed Accutane to treat the acne/boils on the back of his head. But that’s when everything changed. If he didn’t take the Accutane, the boils would return. A recent visit to the dermatologist, Danielle explained, resulted in having to come to terms with long-term baldness. 

“My [boyfriend] is really, really sad,” she wrote. 

Over 40 comments flooded Danielle’s post. While some offered diet tips, suggested supplements, and most encouraged a second opinion: 

“Yeah, I don’t know if that’s acne. It’s just on his head? Sounds like a fungal or bacterial problem. Either way, Accutane is notorious for hair loss and changes in hair texture. So I’d definitely see another dermatologist for a [second] opinion on what to do. In the meantime look into supplements. Careful with biotin, too much can cause more acne and serums and shampoos help promote hair growth.”  – u/EvieKnevie/
 

“How big are the pimples/boils? Not a doctor, but a med student lol so that still didn’t mean anything…but I’ve also had some folliculitis issues and his issue doesn’t quite sound the same. It seems like the Accutane helps but that doesn’t tell you what the underlying problem is, so it’s a good idea to get a second opinion, or chat with his derm again. I’ve seen other subs talk about switching shampoos, like ones with tea tree oil which is antimicrobial so could help if it has to do with bacteria/fungi.” – u/grilledcheeseolive/ 

Dr. Bumpinator said that furuncles, carbuncles, or boils may be similar to folliculitis, but often caused by bacteria. The boil usually causes the skin to swell and consists of accumulated pus and dead tissue. Above all, a furuncle is one boil on the skin, but a carbuncle is a cluster of boils. The carbuncles are typically the type of bump that needs medical attention as the infection gets deeper into the skin (5).

Furthermore, he explained, this often happens where the hair is rubbing on the skin like “the neck, breasts, groin, face and buttocks are common places where people get boils.” 

“Boils on the scalp that won’t go away are a cause for concern,” Dr. Bumpinator said. “If the ‘so-called boils’ don’t go away after a short period of time. It’s time to see a doctor and if they keep returning after treatment, it’s time to consider they’re something else.”

 

3. The Slow Growing Bump: Sebaceous Cysts

Sebaceous Cysts are small growing bumps beneath the skin, but not to worry, they’re not cancerous. The good news, they are rare over the scalp (4). These types of bumps develop when the glands in the skin are damaged or blocked, and the oil is unable to leave the skin. According to Dr. Bumpinator, these types of bumps require surgical removal, and without it, the cyst will usually come back.

Despite the rarity of appearing on the scalp, it can still happen. Reddit user u/parkinglotguy/ shared with the forum’s /r/popping/ community a gruesome photograph of his “walnut-sized sebaceous cyst”: https://i.imgur.com/Gc3J5yo.jpg. 

In a different /r/popping/ thread, u/dallylamma/ featured a video of a hairstylist popping and draining a sebaceous cyst on the top of the scalp: /r/popping/huge sebaceous cyst on head/. 

Dr. Bumpinator recommends that you should not try to self-diagnose. Always see a dermatologist for a diagnosis and management.

4. The Itchy Scalp Acne Or Allergic Reaction?

Scalp acne looks like zits and pimples, but on the scalp or back of the head. These bumps can be itchy and sometimes crusted, according to Dr. Bumpinator. Sometimes, like facial acne, there may be blackheads and whiteheads accompanied with papules and pustules or nodules and cysts. Scalp acne is treated with over the counter products, but if it lingers longer than the norm, consulting with a dermatologist is encouraged.  

Redditor, /u/Skill-Key/, shared a photo of the left side neck and back of the head. In his post he said: 

“…itchy acne on the scalp that turns into itchy rash/bumps on the rest of the body. I’ve had the acne type bumps for almost a month on my scalp and have been using hydrocortisone and Aloe Vera on skin but nothing seems to work and the smaller mosquito-like bumps appear sporadically throughout my body.”

“You probably need to see the derm; hard to eval the scalp with a photo. Could be folliculitis but it’s usually not super itchy. Could be psoriasis! You’ll prob need rx products” – /u/dinophile/

A Note On Psoriasis – Psoriasis is a skin condition where the cells excessively multiply and causes the skin to look scaly, dry, bumpy with red patches, and sometimes bleed (2). Dr. Bumpintor said, usually, psoriasis forms on the scalp, elbows, knees, and lower back. With unique cases of patients experiencing similar effects on the back of their head too. However, a more severe psoriasis case causes red bumpy skin. These types of bumps require different treatments that address psoriasis. 

Other times, bumps similar to /u/Skill-Key could look like an allergic reaction to hair products. For example, if there’s shampoo residue from not washing it out appropriately, the excess, in the long run, could irritate the scalp and cause bumps. 

5. The Fatty Lipoma

A lipoma is a non-cancerous, fatty lump that slowly grows between the skin and muscle. It occurs when there is an overgrowth of fat cells (1). Redditor /u/tylerfmarch/ vented his frustrations and said that after two surgeries to remove a lipoma in the middle of his neck, the alleged lipoma is back, after a recent surgery dating back to five months ago. 

“I can feel it back again. It’s probably about the size of a dime now but it has gotten up to the size of roughly a nickel-ish before, maybe a bit bigger. I’m getting really tired of this. It’s not painful or anything, so I guess I don’t NEED it removed.. it’s just gross. I just want it gone forever. Is this potentially the error of my surgeon missing some pieces? Or am I doomed to have this thing for the rest of my life?”  – /u/tylerfmarch/

“I’m curious about this too. Mine is in a similar location. My derm blames weight gain, but given that mine grew back when I was in a steep caloric deficit I’m having trouble with that explanation. Parts of mine were definitely left behind though, since it was very “diffused” in shape my derm couldn’t get it all removed since I just had local anesthetic. I’m considering seeing a general surgeon and going completely under for my next surgery.” – Anonymous Redditor

Lipomas, after surgery, can sometimes come back, often because they were not completely removed. Dr. Bumpinator said seeking a second opinion, asking for a biopsy, and seeing the results can help better understand these types of bumps. 

6. The Sore Razor Burns, Bumps, and Rashes

Anyone who shaves can get razor burn and the rash to match. Razor burn can cause an irritating and painful rash of small bumps on the skin. The red spots can feel sore and inflamed. The worse part, they could get infected and with large puss-filled bumps.

“I guess a barber didn’t clean his clippers and since that day I’ve had small razor bumps in the back of my head. I can’t have a low cut because the bumps make me self conscious but I hate having long hair. Does anyone have a method or product that can get rid of razor bumps?”

His post also generated a number of comments and insight from other Redditors who suggested he may have folliculitis or sebum build-up. 

“Sounds more like folliculitis than razor bumps. This can be caused through bacteria getting into the skin but if it was 3 years ago it won’t still be present from the clippers, it’s likely that it’s present in your everyday life, which is completely normal. I have it all over my legs. I’d recommend going to your doctor and they should be able to diagnose you and give you something for it.” – u/emmaheath_mua1/

“Doesn’t sound like it had anything to do with your barber, you probably shouldn’t throw them under the bus. To me it just sounds like sebum build up, use exfoliants, Tend Skin is a great one. Or try switching shampoo, if you think about how you rinse off in a shower all the oils and suds run down your neck, perhaps it’s a mild allergy to sulfates, or you’re just not giving it the scrub it needs.” – /u/NatTreav/

Even though a person may – shave with the grain, use clean clippers or razors, not repeatedly shave the same area, practice proper shave care, or use proper moisturization post-shaving, the bumps can still come back.  And that’s when Dr. Bumpinator advises getting an in-depth look at these rashes or bumps. The swelling, tenderness of the skin, itchiness, red bumps, and inflammation paired with bleeding and oozing puss can be signs of acne keloidalis nuchae – AKN or something more serious. Barbers often get blamed unfairly for causing AKN on account of using dirty clippers. But individuals who get AKN following a hair cut, develop it because not from dirtiness of the clippers used, but rather from a genetic predisposition to AKN which is precipitated by shaving the hair short especially in the nape areas.

AKN tends to affect males of color

 

                  

But Did You Know It Could Be AKN?

In some instances, men are unaware that they have AKN. It’s not that these other types of bumps aren’t caused for concern, but AKN is a beast of its own that may require a more aggressive treatment approach. To get a full understanding of your bumps, ask Dr. Bumpinator: 

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References –

1. Cavaco Silva, Joana (January 2020). What is a lipoma? Retrieved from https://www.medicalnewstoday.com/articles/322551
2. Cole, Gary W., (n.d.) Scalp Psoriasis (Psoriasis of the Scalp) https://www.medicinenet.com/scalp_psoriasis/article.htm#what_is_scalp_psoriasis_when_can_scalp_psoriasis_begin
3. Satter, Elizabeth K (2019). Acne keloidalis Nuchae (AKN).  Retrieved from https://emedicine.medscape.com/article/1072149-overview#a7
4. Singla, A., Singh, M., & Singla, S. (2015). Multiple Giant Sebaceous Cysts of Scalp. Journal of clinical and diagnostic research: JCDR, 9(11), PJ01–PJ2. https://doi.org/10.7860/JCDR/2015/15125.6798
5.  What’s the Difference Between a Furuncle and a Carbuncle? (n.d.) Retrieved from https://www.healthline.com/health/furuncle-vs-carbuncle#treatmen
6. Winters RD, Mitchell M. Folliculitis. [Updated 2020 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547754/

Further Reading 

Dirty barber clippers DO NOT are not the cause of Acne Keloidalis Nuchae. Learn the reasons why.

Is there such a thing as an effective DIY home remedy for AKN? Read this post and find out. 

 

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