Dissecting Cellulitis of the Scalp

Scarring, discomfort, and hair loss are the symptoms of a rare skin disorder called scalp dissecting cellulitis. Although there is no known treatment, antiseptic shampoos and oral and topical medicines may be used.

An uncommon skin ailment known as dissecting cellulitis of the scalp (DCS) usually affects young adult Black males. However, irrespective of age, ethnicity, or gender, anyone might be affected by the illness.

Alternatively referred to as Hoffman disease or perifolliculitis capitis abscedens et sufficient, DCS may result from inflammation of clogged hair follicles.

DCS is a chronic illness that can be difficult to manage. We will discuss its symptoms, causes, and therapies in this post. We'll also go over who is most vulnerable and what your chances are of receiving DCS.

What are the symptoms of dissecting cellulitis of the scalp?

Over several months or years, DCS may get worse. DCS patients may initially have painful, elevated lumps, particularly on the top of the head, as a result of blocked hair follicles. The lumps may eventually extend along the length of the scalp.

Symptoms with an early onset include:

• painful, pus-filled lumps and lesions
• patches of hair loss
• secondary bacterial infections (folliculitis)

Early symptoms that are less typical could be:

• fever
• tender or swollen lymph nodes

Later-stage signs and symptoms could be:

• lesions (abscesses) that bleed or secrete pus
• Skin canals or wormlike threads connecting the lesions
• infection-related scarring
• irreversible, uneven, and permanent hair loss that is widespread

What causes dissecting cellulitis of the scalp?

DCS is caused by blocked hair follicles. It is uncertain what the fundamental cause is for this to happen to some individuals but not others.

Hair follicles expand and rupture if they become clogged. This causes the scalp to become severely inflamed by releasing keratin. Common outcomes include scarring, hair loss, and secondary infections.

Who’s at risk of dissecting cellulitis of the scalp?

Those of any colour or gender can be impacted by DCS. But Black men between the ages of 20 and 40 are the most typically affected.

In a 2022 study, researchers discovered a connection between smoking and DCS.

Follicular occlusion tetrad

DCS can coexist with other illnesses that lead to inflammation, rupturing, and obstructions of hair follicles. The following set of circumstances is referred to as the "follicular occlusion tetrad" when it coexists with DCS:

• boils, cysts, and hidradenitis suppurativa that develop in your body's creases
• acne conglobate, a serious form of the disease
• The base of the spine has an infected cyst called the pilonidal sinus.

Other related conditions

DCS may be accompanied by inflammation in other areas of your body, such as the bones and joints (arthritis). Other typical comorbidities include:

• keratitis
• pyoderma gangrenosum
• osteomyelitis
• Crohn’s disease (rarely)
• keratitis-ichthyosis-deafness syndrome

How do doctors diagnose dissecting cellulitis of the scalp?

During a physical examination, a specialist—such as a dermatologist—can visually identify DCS.

To look for underlying illnesses that could be the source of your symptoms, they could take samples of your hair or pus. These samples can be examined in a lab setting under a microscope.

A scalp biopsy may also be advised by a physician in certain cases. This operation can be performed in an outpatient setting, such as a specialist's office.

A medical practitioner will take one or more tiny samples of hair follicles and scalp tissue during the biopsy to submit them to a laboratory for examination. To ease your discomfort, a topical anaesthetic will be given before the biopsy.

What is the treatment for dissecting cellulitis of the scalp?

DCS is a chronic, incurable illness. Treatments can still be used to successfully control active symptoms.

Strategies for reducing discomfort, leaking from wounds, and hair loss are typically part of the treatment for DCS. A medical practitioner will advise you to stop applying oil-based products to your scalp and may also advise you to stop using chemically irritating hair treatments.

Products and medications used to treat DCS consist of:

• steroids applied topically and orally to lower inflammation
• oral and topical antibiotics for infection prevention
• antibacterial rinses and washes to lessen the amount of microorganisms on the hair
• topical retinoids to lessen obstruction of the hair follicles
• oral retinoids to treat severe acne and inhibit the function of the scalp's sebaceous (oil) glands

In rare cases, you might inject steroids straight into your scalp to lessen extremely high inflammation.

If your abscesses are huge and painful, your doctor might drain or surgically remove them.

You might go through periods of remission with DCS, during which you don't have any symptoms, and then you might relapse. Even in the absence of symptoms, a medical professional might advise continuing preventive therapy, such as antiseptic scalp rinses.

What is the outlook for people with dissecting cellulitis of the scalp?

When it comes to treating symptoms like pain, discomfort, and leakage, medical interventions are invaluable. Early therapy initiation may also lessen hair loss. Nonetheless, scarring and hair loss are frequent long-term effects of DCS.

One kind of cicatricial (scarring) alopecia is DCS. Getting involved in a support group for those facing similar circumstances can help you get continuing knowledge and assistance that can help you cope better. Through the National Alopecia Areata Foundation, support groups are offered.

Takeaway

Hair loss, scarring, and painful lesions are all symptoms of the rare disease DCS. Although treatable, this chronic illness cannot be cured. Though anyone can develop HIV, regardless of age, sex, or ethnicity, young Black guys are the ones who are most usually affected.

FAQs

What causes dissecting cellulitis of the scalp?

The cause of DCS is not fully understood.

How do you treat cellulitis on the scalp?

Topical antibiotics like clindamycin lotion and antiseptic shampoos (like chlorhexidine) can both be helpful. 

What is the other name for dissecting cellulitis of the scalp?

Perifolliculitis capitis abscedens et suffodiens or Hoffman disease

What is dissecting cellulitis of the scalp triad?

May be associated with hidradenitis suppurativa, acne conglobata and pilonidal cysts