Volume 5, Issue 1, Pages (January 2019)

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Volume 5, Issue 1, Pages 24-28 (January 2019) Patient selection criteria and innovative techniques for improving outcome and cosmesis in acne keloidalis nuchae lesion excision and primary closure Sanusi Umar, MD, Jason R. Castillo, MD, Consuelo V. David, MD, MSc, Sophia Sandhu, MD JAAD Case Reports Volume 5, Issue 1, Pages 24-28 (January 2019) DOI: 10.1016/j.jdcr.2018.10.002 Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 1 Side and back view of the head show anatomical landmarks and posterior scale. JAAD Case Reports 2019 5, 24-28DOI: (10.1016/j.jdcr.2018.10.002) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 2 Patient 1, an African man, age 49 years, with a lesion of less than 2.5 cm vertical width in the upper half of the nuchal area. JAAD Case Reports 2019 5, 24-28DOI: (10.1016/j.jdcr.2018.10.002) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 3 Steps A-E show the methodology of elliptic AKN excision, trichophytic excision of inferior wound margin, trichophytic closure, and postsurgery. JAAD Case Reports 2019 5, 24-28DOI: (10.1016/j.jdcr.2018.10.002) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 4 Patient 1 one year after AKN excision with trichophytic closure. The scar is still thin and well camouflaged. JAAD Case Reports 2019 5, 24-28DOI: (10.1016/j.jdcr.2018.10.002) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 5 Steps A-C show the methodology of insertion of deep interrupted sutures and trichophytic closure after elliptical AKN excison and trichopytic excision of inferior wound margin. JAAD Case Reports 2019 5, 24-28DOI: (10.1016/j.jdcr.2018.10.002) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 6 Patient 2 after application of tension sutures that are padded with povidone-iodine–soaked gauze pads. JAAD Case Reports 2019 5, 24-28DOI: (10.1016/j.jdcr.2018.10.002) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 7 Patient 2 at 4 months. The scar is thin, with hair growing through to camouflage it. Residual AKN was treated with clobetasol solution. JAAD Case Reports 2019 5, 24-28DOI: (10.1016/j.jdcr.2018.10.002) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions