Dissecting Cellulitis

Overview

Dissecting cellulitis of the scalp is an uncommon scalp condition that causes painful lumps filled with pus develop, often leading to scarring and patchy areas of permanent hair loss. It most frequently affects black men 20-40 years of age. It is a chronic condition and while treatment of symptoms can provide some relief, patients tend to  acne, hidradenitis suppurativa, or pilonidal cysts (cysts near the cleft of the buttocks

Cause

The underlying cause of this condition is unknown, but it's believed to be the result of blockages in the hair follicles on the scalp. Once these follicles are blocked, material begins to accumulate inside them, causing swelling and sometimes rupture. When the follicle ruptures, keratin (a type of skin protein) is released into the surrounding tissue, triggering an inflammatory response. In some cases, these lesions can become secondarily infected with bacteria or fungi, resulting in folliculitis.

Symptoms

Symptoms include tender lumps, abscesses, and patches of hair loss (alopecia). Sores often ooze pus or bleed, and you may see tiny tracts between some of these lesions. Occasionally people with this condition also have swollen lymph nodes that are painful to touch and/or a fever.

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Diagnosis

After examining your scalp, a dermatologist will usually diagnose the condition. In some cases though, they may require confirmation through a biopsy that is done under local anesthesia.

Treatment

There is no cure for dissecting cellulitis however there are treatments to control symptoms including topical and oral options. Oral steroids and steroid injections can improve symptoms during acute flares. Brief courses of antibiotics such as doxycycline can also be helpful both for antimicrobial and anti-inflammatory properties. Severe disease may require other systemic medications or surgery. Oral isotretinoin (commonly known as Accutane, a medication related to vitamin A), has an anti-inflammatory effect and suppresses the activity of sebaceous glands, which contribute to the disease. Extended treatment is often needed for improvement. Patients generally tolerate the medication without issues however lab monitoring is required to monitor for side effects.