Background: Acne keloidalis nuchae (AKN) is a very challenging dermatological problem for treatment depending on its chronicity and cosmetic disfiguring thus, we aim to assess the efficacy of both injection of botulinum neurotoxin A (BoNT/A) intralesionaly and long pulsed Nd:YAG laser for treatment alongside with combination of both treatment. Methods: Male patients suffering from Acne Keloidalis Nuchae divided into three groups. All patients diagnosed clinically and assessed before and after treatment with Vancouver scare scale (VSS) and global aesthetic improvement scale. Results: There were significant response for treatment of AKN with Nd:YAG laser rather than intralesional injection of BoNT/A. There was significant differences regarding global aesthetic improvement scale. Conclusion: Both long pulsed Nd YAG laser and intralesional injection of botox for treatment of Acne keloidalis nuchae may be effective.