Dissecting cellulitis of the scalp with typical clinical features: A retrospective cross‐sectional study in a Department of Dermatology, Beijing, China

Abstract

Dissecting cellulitis of the scalp (DCS), also referred to as perifolliculitis capitis absecedens and suffodiens and dissecting folliculitis of the scalp, is a rare disease. 1 DCS initially presents as folliculitis on the top of the head and occipital scalp. Subsequently, the folliculitis can develop into inflammatory pustules, nodules, draining sinus tracts, and scarring alopecia. 2 DCS can cause pain and itching and may cause physical disfigurement and emotional trauma. [3][4][5] When folliculitis presents, it is difficult to predict whether it will progress to DCS. The etiology of DCS is unknown. 1 Trauma may trigger DCS. 6 Dissecting cellulitis of the scalp was first described by Spitzer (1903) and generally affects black men aged 30-60 years. 7,8 DCS can occur alone or in combination with other diseases. DCS combined with hidradenitis suppurativa (HS) and acne conglobata (AC) is characterized as follicular occlusion triad (FOT). 6 Follicular occlusion tetrad refers to FOT combined with pilonidal sinus. 1 The histopathology of DCS appears as distension of the follicular infundibula with perifollicular mixed inflammation; the mixed inflammatory cells are infiltrated in the dermis or subcutaneous level, which can lead to the destruction of follicular units. 2 The pathology of DCS is similar to that of HS, AC, and pilonidal sinus, all of which are part of the follicular occlusion tetrad. 2,9 Some investigators suggest that DCS is HS of the scalp. 10 Most published literature on DCS has been case reports or case series. Few of these studies included a large population or Asians.The current study is a cross-sectional study of 169 patients from a single tertiary medical center in Beijing. Given the association between DCS and FOT, DCS was stratified by FOT. | ME THODS | Design and settingThis was a retrospective, cross-sectional study that was exempted from ethical review by the Beijing Youan Hospital, affiliated with Capital Medical University. The study was implemented in accordance with the relevant regulations and the Declaration of Helsinki.

Endocrine and metabolic comorbidities in primary cicatricial alopecia: A nationwide population‐based study

“…Although FD and DC are distinct neutrophilic PCAs, the two disorders showed similar metabolic comorbidity profiles in the present study, except for the decreased risk for hypothyroidism in patients with DC. To our knowledge, the present study is the first to investigate endocrine and metabolic comorbidities in patients with FD or DC 24,44,45 . Obesity and smoking have been shown to have various correlations with DC, 23,46 suggesting a possible role of chronic inflammation associated with obesity and smoking in the permanent destruction of hair follicles 23,47,48 .…”

“…investigate endocrine and metabolic comorbidities in patients with FD or DC. 24,44,45 Obesity and smoking have been shown to have various correlations with DC, 23,46 suggesting a possible role of chronic inflammation associated with obesity and smoking in the permanent destruction of hair follicles. 23,47,48 In the present study, both FD and DC were significantly associated with dyslipidemia, diabetes, and hypertension, even after adjusting for BMI and smoking.…”