Modern external beam radiation therapy for refractory dissecting cellulitis of the scalp

Abstract

Using modern techniques and equipment, radiation therapy appears to be a reasonable option for patients with severe/refractory dissecting cellulitis of the scalp. Acute effects are mild and well tolerated. Aside from alopecia, which was present to some extent in all patients before treatment, no long-term complications have been observed.

Treatment of acne conglobata with modern external beam radiation

“…7,8 Radiation-induced epilation destroys the hair follicle and removes the nidus for ongoing inflammation. 6 Low-voltage x-rays were used historically to treat acne 9 and hidradenitis suppurativa. 10 X-ray therapy for acne had fallen out of favor by 1970 for many reasons, including cost to the provider, perceived risk of secondary malignancies, public resistance to radiotherapy, discontinued teaching in residency programs, and improved alternative therapies for acne.…”

“…4,5 In 2005, successful use of modern external beam radiation was reported in 4 cases of dissecting cellulitis of the scalp. 6 Given that dissecting cellulitis of the scalp and acne conglobata are both members of the follicular occlusion tetrad, we postulated that external beam radiation would also be effective for acne conglobata. Under the supervision of a radiation oncologist, the patient received a total of 8 treatments of modern external beam radiation over 2 weeks localized to the bilateral mandibular cheeks.…”

What′s new in cicatricial alopecia?

“…Low dose corticosteroids [163] Colchicine [60,64] Dapsone [60,64] Excision and skin grafting [165,166] Lasers and radiotherapy [167,168,169] Acne keloidalis nuchae [82,228] First line Potent topical steroids [65,170] Oral antibiotics+topical steroids/intralesional triamcinolone [65,170] …”

Primary Cicatricial Alopecia

“…In mild to moderate disease (arbitrarily defined as under 20 lesions), topical clindamycin is the first agent of choice. In a study of ten subjects treated with 1% clindamycin lotion twice daily (undisclosed duration) improvement occurred in all subjects and there was complete clearance in 30% excluding larger keloidal lesions [37]. In more extensive disease, an oral antibiotic may be required.…”

“…Adjunctive use of antibiotic soaps has been advocated. In partial responders with papular disease, the addition of a topical corticosteroid may further improve outcome [37]. Used alone a modest improvement can be expected (pulsed clobetasol propionate 0.05% foam twice daily, with a 2-week on/off regimen for 8 weeks; flares may occur during off times) [31].…”