Acne keloidalis nuchae (AKN) is a chronic folliculitis and perifolliculitis usually found over occipital scalp and posterior neck, especially in black men. It presents clinically as follicular papules that coalesce into firm hypertrophic plaques and nodules. Although the etiology is unknown, multiple causes have been suggested. A 20-year-old Korean man presented with multiple pink colored firm papules on his posterior neck. The lesions had grown slowly over a period of time since he underwent curettage as a treatment of molluscum contagiosum about 10 years ago. He had no history of keloid formation. After physical and laboratory examinations, the patient was found to meet the criteria of metabolic syndrome. Histological examination revealed several follicular units in chronic active inflammation with foreign body granulomatous reaction. From clinical and histological findings, the patient was diagnosed with AKN. AKN is relatively common in western countries, but only a few cases have been reported in Korea. Furthermore, to our knowledge, this is first time to document an AKN developed after curettage in a patient with metabolic syndrome in Korea. Although possible association between metabolic syndrome and AKN has been previously suggested, exact relationship is still unclear. Herein, we report a case of AKN developed in a patient with metabolic syndrome and suggest that AKN may be possible cutaneous feature of metabolic syndrome.