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 .To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Scheinfeld N. Dissecting cellulitis (Perifolliculitis Capitis Abscedens et Suffodiens): a comprehensive review focusing on new treatments and findings of the last decade with commentary comparing the therapies and causes of dissecting cellulitis to hidradenitis suppurativa. Dermatol Online J 2014; 20:22692.
- Olsen EA, Bergfeld WF, Cotsarelis G, et al. Summary of North American Hair Research Society (NAHRS)-sponsored Workshop on Cicatricial Alopecia, Duke University Medical Center, February 10 and 11, 2001. J Am Acad Dermatol 2003; 48:103.
- Levy M. Diaper rash syndrome or dermatitis. Cutis 2001; 67:37.
- Koca R, Altinyazar HC, Ozen OI, Tekin NS. Dissecting cellulitis in a white male: response to isotretinoin. Int J Dermatol 2002; 41:509.
- Greenblatt DT, Sheth N, Teixeira F. Dissecting cellulitis of the scalp responding to oral quinolones. Clin Exp Dermatol 2008; 33:99.
- Stein LL, Adams EG, Holcomb KZ. Inflammatory tinea capitis mimicking dissecting cellulitis in a postpubertal male: a case report and review of the literature. Mycoses 2013; 56:596.
- Segurado-Miravalles G, Camacho-Martínez FM, Arias-Santiago S, et al. Epidemiology, clinical presentation and therapeutic approach in a multicentre series of dissecting cellulitis of the scalp. J Eur Acad Dermatol Venereol 2017; 31:e199.
- Ramesh V. Dissecting cellulitis of the scalp in 2 girls. Dermatologica 1990; 180:48.
- El Sayed F, Ammoury A, Dhaybi R, et al. Perifolliculitis capitis abscedens et suffodiens: an unusual case triggered by trauma. J Eur Acad Dermatol Venereol 2006; 20:1143.
- Arneja JS, Vashi CN, Gursel E, Lelli JL. Management of fulminant dissecting cellulitis of the scalp in the pediatric population: Case report and literature review. Can J Plast Surg 2007; 15:211.
- Williams CN, Cohen M, Ronan SG, Lewandowski CA. Dissecting cellulitis of the scalp. Plast Reconstr Surg 1986; 77:378.
- Brook I. Recovery of anaerobic bacteria from a case of dissecting cellulitis. Int J Dermatol 2006; 45:168.
- Mundi JP, Marmon S, Fischer M, et al. Dissecting cellulitis of the scalp. Dermatol Online J 2012; 18:8.
- Badaoui A, Reygagne P, Cavelier-Balloy B, et al. Dissecting cellulitis of the scalp: a retrospective study of 51 patients and review of literature. Br J Dermatol 2016; 174:421.
- Prasad SC, Bygum A. Successful treatment with alitretinoin of dissecting cellulitis of the scalp in keratitis-ichthyosis-deafness syndrome. Acta Derm Venereol 2013; 93:473.
- Thein M, Hogarth MB, Acland K. Seronegative arthritis associated with the follicular occlusion triad. Clin Exp Dermatol 2004; 29:550.
- Libow LF, Friar DA. Arthropathy associated with cystic acne, hidradenitis suppurativa, and perifolliculitis capitis abscedens et suffodiens: treatment with isotretinoin. Cutis 1999; 64:87.
- Ongchi DR, Fleming MG, Harris CA. Sternocostoclavicular hyperostosis: two cases with differing dermatologic syndromes. J Rheumatol 1990; 17:1415.
- Whiting DA. Cicatricial alopecia: clinico-pathological findings and treatment. Clin Dermatol 2001; 19:211.
- Brănişteanu DE, Molodoi A, Ciobanu D, et al. The importance of histopathologic aspects in the diagnosis of dissecting cellulitis of the scalp. Rom J Morphol Embryol 2009; 50:719.
- Mubki T, Rudnicka L, Olszewska M, Shapiro J. Evaluation and diagnosis of the hair loss patient: part II. Trichoscopic and laboratory evaluations. J Am Acad Dermatol 2014; 71:431.e1.
- Sperling LC. Inflammatory tinea capitis (kerion) mimicking dissecting cellulitis. Occurrence in two adolescents. Int J Dermatol 1991; 30:190.
- Onderdijk AJ, Boer J. Successful treatment of dissecting cellulitis with ciprofloxacin. Clin Exp Dermatol 2010; 35:440.
- Onderdijk AJ, Boer J. Successful treatment of dissecting cellulitis with ciprofloxacin. Clin Exp Dermatol 2009; 34:e507.
- Bolz S, Jappe U, Hartschuh W. Successful treatment of perifolliculitis capitis abscedens et suffodiens with combined isotretinoin and dapsone. J Dtsch Dermatol Ges 2008; 6:44.
- Koudoukpo C, Abdennader S, Cavelier-Balloy B, et al. [Dissecting cellulitis of the scalp: a retrospective study of 7 cases confirming the efficacy of oral isotretinoin]. Ann Dermatol Venereol 2014; 141:500.
- Georgala S, Korfitis C, Ioannidou D, et al. Dissecting cellulitis of the scalp treated with rifampicin and isotretinoin: case reports. Cutis 2008; 82:195.
- Khaled A, Zeglaoui F, Zoghlami A, et al. Dissecting cellulitis of the scalp: response to isotretinoin. J Eur Acad Dermatol Venereol 2007; 21:1430.
- Dhaoui MA, Mebazaa A, Doss N. [Dissecting cellulitis of the scalp: treatment by isotretinoine]. Ann Dermatol Venereol 2001; 128:688.
- Scerri L, Williams HC, Allen BR. Dissecting cellulitis of the scalp: response to isotretinoin. Br J Dermatol 1996; 134:1105.
- Taylor AE. Dissecting cellulitis of the scalp: response to isotretinoin. Lancet 1987; 2:225.
- Berne B, Venge P, Ohman S. Perifolliculitis capitis abscedens et suffodiens (Hoffman). Complete healing associated with oral zinc therapy. Arch Dermatol 1985; 121:1028.
- Kobayashi H, Aiba S, Tagami H. Successful treatment of dissecting cellulitis and acne conglobata with oral zinc. Br J Dermatol 1999; 141:1137.
- Wollina U, Gemmeke A, Koch A. Dissecting Cellulitis of the Scalp Responding to Intravenous Tumor Necrosis Factor-alpha Antagonist. J Clin Aesthet Dermatol 2012; 5:36.
- Brandt HR, Malheiros AP, Teixeira MG, Machado MC. Perifolliculitis capitis abscedens et suffodiens successfully controlled with infliximab. Br J Dermatol 2008; 159:506.
- Mansouri Y, Martin-Clavijo A, Newsome P, Kaur MR. Dissecting cellulitis of the scalp treated with tumour necrosis factor-α inhibitors: experience with two agents. Br J Dermatol 2016; 174:916.
- Martin-García RF, Rullán JM. Refractory dissecting Cellulitis of the Scalp Successfully controlled with Adalimumab. P R Health Sci J 2015; 34:102.
- Navarini AA, Trüeb RM. 3 cases of dissecting cellulitis of the scalp treated with adalimumab: control of inflammation within residual structural disease. Arch Dermatol 2010; 146:517.
- Sukhatme SV, Lenzy YM, Gottlieb AB. Refractory dissecting cellulitis of the scalp treated with adalimumab. J Drugs Dermatol 2008; 7:981.
- Boyd AS, Binhlam JQ. Use of an 800-nm pulsed-diode laser in the treatment of recalcitrant dissecting cellulitis of the scalp. Arch Dermatol 2002; 138:1291.
- Krasner BD, Hamzavi FH, Murakawa GJ, Hamzavi IH. Dissecting cellulitis treated with the long-pulsed Nd:YAG laser. Dermatol Surg 2006; 32:1039.
- Glass LF, Berman B, Laub D. Treatment of perifolliculitis capitis abscedens et suffodiens with the carbon dioxide laser. J Dermatol Surg Oncol 1989; 15:673.
- Bellew SG, Nemerofsky R, Schwartz RA, Granick MS. Successful treatment of recalcitrant dissecting cellulitis of the scalp with complete scalp excision and split-thickness skin graft. Dermatol Surg 2003; 29:1068.
- Housewright CD, Rensvold E, Tidwell J, et al. Excisional surgery (scalpectomy) for dissecting cellulitis of the scalp. Dermatol Surg 2011; 37:1189.
- Asemota E, Chang YC, Goldberg LJ. Innovative Management of Recalcitrant Dissecting Cellulitis With Compression Therapy. JAMA Dermatol 2016; 152:1280.
- Curry SS, Gaither DH, King LE Jr. Squamous cell carcinoma arising in dissecting perifolliculitis of the scalp. A case report and review of secondary squamous cell carcinomas. J Am Acad Dermatol 1981; 4:673.
- Ramasastry SS, Granick MS, Boyd JB, Futrell JW. Severe perifolliculitis capitis with osteomyelitis. Ann Plast Surg 1987; 18:241.
- 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