A Review of Treatments for Dissecting Cellulitis of the Scalp

Abstract

Dissecting cellulitis of the scalp (DCS) is a rare and chronic skin disorder that presents with suppurative nodules on the scalp with associated scarring alopecia. The pathogenesis of the disease involves inflammation and destruction of the hair follicle. This makes it clinically and pathologically similar to acne conglobata and hidradenitis suppurativa, which can also occur concomitantly. Many therapies exist to treat DCS, but its refractory nature makes treatment difficult and combination therapies are often needed. The aim of this review is to evaluate the evidence-based medical and surgical treatments for this disease so that clinicians can choose the best treatments according to the disease stage and severity. Knowledge of the clinical endpoints of each treatment modality is important for managing patient expectations and setting treatment goals. There is no standardized method for measurement of clinical improvement in DCS, and each individual treatment can improve one or more aspect of disease activity (such as inflammation or scarring). Topical and oral medications will be reviewed in addition to surgical and laser treatments.