Dermatology Education

Dissecting Cellulitis of the Scalp

Nitin K. Garg and Roopal V. Kundu, MD

Dissecting cellulitis of the scalp (also known as perifolliculitis capitis abscedens et suffodiens) is an uncommon scalp condition that mostly affects black men 20-40 years of age, but may also affect other races and/or women. Painful lumps filled with pus develop, often leading to scarring and patchy areas of permanent hair loss. It may persist for several years, and recurrence is a problem. It is sometimes associated with other skin problems such as acne, hidradenitis suppurativa, or pilonidal cysts (cysts near the cleft of the buttocks).1,2

What is the cause of dissecting cellulitis of the scalp?
The exact cause is unknown. However, it is thought to be caused by blockage of hair follicles in the scalp. Following blockage, material accumulates in the follicle, causing swelling and rupture. The keratin (skin protein) that is released from the ruptured follicle leads to an inflammatory response.1 These lesions can become secondarily infected leading to folliculitis or perifolliculitis.

How do I know if I have dissecting cellulitis of the scalp?
Signs of this condition include painful lumps, abscesses, and patchy areas of hair loss in the scalp. These lesions often ooze pus or bleed, and you may notice small tracts between some of these lesions. Less commonly, tender lymph nodes and/or fever may occur. The condition is usually diagnosed by a dermatologist after examination of your scalp, but in some cases, a biopsy under local anesthesia may be required for confirmation.

What treatments are available for dissecting cellulitis of the scalp?
There is no permanent cure. Many topical and oral treatments are available to help control this disease.1,2 Oral steroids and local steroid injections have been used for short term management of the disease. Short courses of antibiotics, most commonly of the tetracycline family, are used. Severe disease may require other systemic medications or surgery.1,2 Oral isotretinoin, a medication related to vitamin A, has an anti-inflammatory effect and suppresses the activity of oil glands (known as sebaceous glands), which contribute to the disease. Treatment for 6 months or more may be needed to control the disease. Most patients tolerate the medication well, but periodic blood tests are required for monitoring of potential side effects of isotretinoin.

Additional resources:
Emedicine Dermatology
Alopecia Support Group

References:

  1. Mundi, J.P., et al. Dissecting cellulitis of the scalp. Dermatology online journal 18, 8 (2012).
  2. Ross, E.K., Tan, E. & Shapiro, J. Update on primary cicatricial alopecias. Journal of the American Academy of Dermatology 53, 1-37; quiz 38-40 (2005).
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