Dissecting cellulitis of the scalp
- Andrew F Alexis, MD, MPH
Andrew F Alexis, MD, MPH
- Associate Professor
- Icahn School of Medicine, Mt. Sinai St. Luke's and Roosevelt Hospitals
Dissecting cellulitis of the scalp (DCS), also known as perifolliculitis capitis abscedens et suffodiens or Hoffman disease, is a chronic inflammatory disorder of the scalp characterized by boggy, suppurative nodules that are often associated with patchy hair loss (picture 1A-E). Follicular occlusion may be a key pathogenic event in the development of DCS. DCS may occur in association with other follicular occlusive disorders such as acne conglobata, hidradenitis suppurativa, and pilonidal cysts .
Data on treatment options for DCS are limited. Oral antibiotics and oral isotretinoin are the most commonly used treatments.
The clinical features, diagnosis, and management of DCS will be reviewed here. An overview of the characteristics and diagnosis of hair loss is provided separately. (See "Evaluation and diagnosis of hair loss".)
DCS is a type of primary cicatricial (scarring) alopecia, a group of inflammatory disorders that target hair follicles and result in follicular destruction and permanent hair loss. A classification scheme proposed by the participants of a 2001 workshop on cicatricial alopecia sponsored by the North American Hair Research Society further classified DCS as a neutrophilic form of primary cicatricial alopecia based upon pathologic features . (See "Evaluation and diagnosis of hair loss", section on 'Classification' and 'Histopathology' below.)
DCS most commonly occurs in black males aged 20 to 40 years. However, DCS has also been reported in Caucasians [3,4] and other racial or ethnic groups [1,5-7], as well as in females [8,9] and adolescents .
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- CLINICAL FEATURES
- ASSOCIATED DISORDERS
- History and physical examination
- DIFFERENTIAL DIAGNOSIS
- First-line therapy
- - Mild to moderate disease
- Oral antibiotics
- - Severe disease
- Oral isotretinoin
- Adjunctive interventions
- - Intralesional corticosteroids
- - Incision and drainage
- - Topical antimicrobial cleansers
- Other therapies
- - Oral zinc sulfate
- - Biologic TNF inhibitors
- - Procedural therapies
- SUMMARY AND RECOMMENDATIONS