Dissecting Cellulitis of the Scalp

Perifolliculitis Capitis Abscedens et Suffodiens

Overview

Dissecting cellulitis of the scalp (perifolliculitis capitis abscedens et suffodiens) is a rare, chronic, inflammatory condition of the scalp characterized by deep-seated, fluctuant nodules, abscesses, and interconnecting sinus tracts that drain purulent material. It is part of the follicular occlusion tetrad along with hidradenitis suppurativa, acne conglobata, and pilonidal cysts. It primarily affects young Black men and leads to scarring alopecia.

Key Symptoms

• Deep, fluctuant, tender nodules and abscesses on the scalp
• Interconnecting sinus tracts between nodules
• Purulent (pus) drainage from nodules and sinuses
• Permanent scarring hair loss (cicatricial alopecia) in affected areas
• Boggy, soft scalp tissue overlying the lesions
• Chronic relapsing course with periods of flare and relative quiescence

Affected Areas

Scalp (vertex and occipital region most common)

Care Instructions

1. See a dermatologist for evaluation and long-term management.
2. Oral antibiotics (doxycycline, rifampin with clindamycin) for anti-inflammatory and antibacterial effect.
3. Intralesional corticosteroids to reduce inflammation in individual nodules.
4. Isotretinoin may be beneficial for recalcitrant disease.
5. Incision and drainage may be needed for large, fluctuant abscesses.
6. Biologic agents (adalimumab) have shown promise in severe, refractory cases.

Medical Disclaimer: This information is for educational purposes only and does not replace professional medical advice. Always consult a qualified dermatologist for diagnosis and treatment.

Prevalence: Rare; primarily affects young men of African descent aged 20-40