Successful Treatment of Recalcitrant Dissecting Cellulitis of the Scalp With Complete Scalp Excision and Split-Thickness Skin Graft

Bellew, S.; Nemerofsky, Robert; Schwartz, Robert A.; Granick, Mark S.

doi:10.1097/00042728-200310000-00017

Cited by 9 publications

(11 citation statements)

References 19 publications

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“…In 1986, Williams and colleagues first reported successful treatment with complete scalp excision followed by split‐thickness skin grafting 13 . Two recent reports also described the benefit of complete excision of the scalp for dissecting cellulitis 14,15 . It appears that, as with hidradenitis suppurativa, complete excision of the diseased skin results in long‐term remission of dissecting cellulitis.…”

Section: Discussionmentioning

confidence: 99%

Excisional Surgery (Scalpectomy) for Dissecting Cellulitis of the Scalp

Housewright¹,

Rensvold²,

Tidwell

et al. 2011

Dermatologic Surgery

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A 25-year-old African-American man presented with a 3-year history of recurrent pustules, sinus tracts, and scarring of the scalp and sinus tract formation in the axillae. He was diagnosed with dissecting cellulitis of the scalp and hidradenitis suppurativa.The scalp condition was nonresponsive to trials of oral prednisone and topical and oral clindamycin before presentation to our clinic. Local incision and drainage of lesions and intralesional steroids provided temporary symptomatic relief. He completed two courses of systemic isotretinoin with minimal improvement and failed several months of etanercept, an anti-tumor necrosis factor alpha (TNF-a) inhibitor. Radiation-induced epilation was considered, but his insurance carrier did not approve it. Because the scalp disorder was progressing, disfiguring, and a social stigma for him, he underwent total scalp excision (Figures 1 and 2) followed by split-thickness skin grafting (Figure 3) for definitive therapy. He tolerated the procedure well, experienced relief of symptoms, and was pleased with his final outcome (Figure 4). DiscussionDissecting cellulitis of the scalp, also known as perifolliculitis capitis abscedens et suffodiens, is a chronic, relapsing inflammatory disease of the scalp most commonly occurring in African-American men in the second to fourth decades of life. It is acknowledged to be one part of the follicular occlusion triad, along with acne conglobata and hidradenitis suppurativa. 1 The likely mechanism is related to follicular hyperkeratosis and occlusion. Ruptured follicles initiate a neutrophilic and granulomatous inflammatory response. 2 These recurrent inflammatory papules, nodules, pustules, and sinus tracts commonly involve the vertex and occipital scalp. The chronic inflammatory response eventually results in scarring and alopecia, which can be painful and disfiguring. 1

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Section: Discussionmentioning

confidence: 99%

Excisional Surgery (Scalpectomy) for Dissecting Cellulitis of the Scalp

Housewright¹,

Rensvold²,

Tidwell

et al. 2011

Dermatologic Surgery

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“…Radical excision of affected areas in PCAS should theoretically be helpful. In 1967 Moschella et al described excision of large areas of affected skin [3] and in 2003 Bellow et al reported successful complete scalp excision and split‐thickness skin grafting [4]. Various treatment approaches with drug therapies are also discussed in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…reported successful complete scalp excision and split-thickness skin grafting [4]. Various treatment approaches with drug therapies are also discussed in the literature.…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of perifolliculitis capitis abscedens et suffodiens with combined isotretinoin and dapsone

Bolz

Jappe²,

Hartschuh³

2007

J Deutsche Derma Gesell

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Perifolliculitis capitis abscedens et suffodiens (PCAS) is a rare scalp disease of unknown etiology which is hard to treat. It is often accompanied by scarring alopecia, acne conglobata, and recurrent fluctuant abscesses. PCAS belongs to the family of acne inversa (hidradenitis suppurativa). A 19-year-old man presented with PCAS for 2 years; multiple systemic antibiotic therapies and surgical approaches had shown no effect. Monotherapy with isotretinoin 80 mg daily for 4 weeks had not been successful. Combination therapy with dapsone 100 mg and isotretinoin 80 mg daily produced significant improvement. During 4 weeks of treatment significant clearing was achieved. Dapsone was reduced to 50 mg daily after 6 months, while isotretinoin was discontinued gradually. Now the patient is on dapsone 50 mg every other day and has remained free of recurrences for 6 months.

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“…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] …”

Section: Third Linementioning

confidence: 99%

What′s new in cicatricial alopecia?

Dogra¹,

Sarangal²

2013

Indian J Dermatol Venereol Leprol

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Scalp hairs complete the body self-image and patients with alopecia suffer from overt disfiguration, leading to psychosocial embarrassment and significant lack of self-esteem. Hence an early diagnosis and an aggressive treatment in the case of active hair loss are crucial in the management of scarring alopecia. This review presents a comprehensive study of newer theories in aetiopathogenesis, evolving diagnostic modalities and a step ladder approach in management of primary cicatricial alopecia.

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Successful Treatment of Recalcitrant Dissecting Cellulitis of the Scalp With Complete Scalp Excision and Split-Thickness Skin Graft

Cited by 9 publications

References 19 publications

Excisional Surgery (Scalpectomy) for Dissecting Cellulitis of the Scalp

Excisional Surgery (Scalpectomy) for Dissecting Cellulitis of the Scalp

Successful treatment of perifolliculitis capitis abscedens et suffodiens with combined isotretinoin and dapsone

What′s new in cicatricial alopecia?

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