Dissecting Cellulitis of the Scalp: A Rare Dermatological Manifestation of Crohnʼs Disease

Syed, Taseen; Asad, Zain Ul Abideen; Salem, G; Garg, Kanika; Rubin, Erin; Agudelo, Nelson

doi:10.14309/crj.2018.8

Cited by 12 publications

(11 citation statements)

References 7 publications

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“…FOT is clinically diagnosed, and biopsy is not essential for the diagnosis [4]. The three components of FOT have similar skin manifestations [8]. However, the location of the lesions usually allows the differentiation of each [4,8].…”

Section: Discussionmentioning

confidence: 99%

“…However, the location of the lesions usually allows the differentiation of each [4,8]. When the skin lesions are located at an intertriginous area such as the axilla, groin, submammary fold, perineum, buttocks, or behind the ears, the condition can be diagnosed as HS; if the lesions are on the face, neck, chest, upper shoulders, arms, buttocks and thighs, the condition is most likely AC; and when the lesions are on the scalp, the condition is diagnosed as DCS [4,8].…”

Section: Discussionmentioning

confidence: 99%

“…Several chronic pyloritic hypersensitivity diseases, such as inflammatory bowel diseases, Crohn's disease, Adamantiades-Behçet disease, and spondylarthritis have been reported in patients with HS [11]. Arthritis, keratitis, pyoderma gangrenosum, and rarely, Crohn's disease, have been reported in patients with DCS [8]. Patients with FOT accompanied by pilonidal sinus may be diagnosed with follicular occlusion tetrad [3].…”

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Follicular Occlusion Triad: A Case Report

et al. 2021

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Follicular occlusion triad (FOT) is a complex chronic inflammatory skin disease comprising hidradenitis suppurativa (HS), acne conglobata (AC), and dissecting cellulitis of the scalp (DCS; Hoffman’s disease or perifolliculitis capitis abscedens et suffodiens). While pathological mechanisms are responsible for common skin manifestations, the exact underlying causes of follicular occlusion have not yet been clearly identified. Therefore, the diagnosis and treatment of FOT remain challenging. A 31-year-old man on conservative treatment for previously diagnosed HS and AC presented to our clinic with multiple masses on his posterior neck and face. Excisional biopsy of the masses revealed epidermal cysts. Four months after the surgery, he presented with a painful palpable mass around the occipital region of the scalp with characteristic skin manifestations such as cicatricial alopecia and comedones and was diagnosed with DCS. Incision and drainage of the lesion were performed, and histopathology revealed pathological findings of follicular occlusion. The patient was diagnosed with FOT. Following the procedure, the patient has been on regular follow-up and is on oral isotretinoin; there have been no complications for the last 6 months.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

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Follicular Occlusion Triad: A Case Report

et al. 2021

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“…11 , 20 Anecdotal evidence of an association with Crohn’s disease is also reported in the literature. 23 Bacterial culture of purulence, that is sterile along with the effectiveness of anti-inflammatory immunomodulators, highlights an abnormal inflammatory process. 24 Other reports of positive cultures combined with the fact that DCS can improve with antibiotic therapy imply an element of disease potentiation with suprainfection.…”

Section: Discussionmentioning

confidence: 99%

Dissecting Cellulitis of the Scalp: A Review and Case Studies of Surgical Reconstruction

Cuellar

Roh

Sampson

2020

Plastic and Reconstructive Surgery - Global Open

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Background: Dissecting cellulitis of the scalp (DCS) is a part of the follicular occlusion tetrad (hidradenitis, acne conglobata, and pilonidal disease). It is a spectrum disorder that can be severe and refractory to medical management. The authors describe 3 such cases successfully treated with surgical resection and reconstruction and present a scoring system for timely referral of such patients to a reconstructive surgical team. Methods: A literature review of all available cases of DCS was undertaken, and the treatments and outcomes were reviewed. Our institution has had 3 recent cases that demonstrated delayed presentation common in the severe spectrum of this condition. All underwent radical surgical resection and reconstruction with skin grafting that was very positively received by all the patients. Results: Three cases of DCS were treated with radical scalpectomy, and split-thickness skin grafting was done with a good cosmetic outcome and a high degree of subjective patient satisfaction. All would have received timely referral if the presented scoring system had been applied earlier. Conclusions: DCS is a rare but debilitating condition that may progress to a medically refractory condition requiring surgical intervention. Surgical resection and skin grafting offer a durable cure, but delayed presentations are common. Use of a scoring system may reduce the time to surgical referral for refractory cases.

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“…Discoid lupus erythematous (DLE) of the scalp is another primary lymphocytic cicatricial alopecia that typically presents with multiple hairless patches. e. Dissecting cellulitis of the scalp, also known as perifolliculitis capitis abscedens et suffodiens or Hoffman disease, is a primary neutrophilic cicatricial alopecia that initially presents with boggy areas of the scalp, inflammatory nodules, pustules, and sinuses that evolve into scarring alopecia (Syed et al 2018). Dissecting cellulitis of the scalp is part of the follicular triad along with hidradenitis suppurativa and acne conglobata (Syed et al 2018…”

Section: Discussion Of Incorrect Answersmentioning

confidence: 99%