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

Abstract

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.

A Case of Dissecting Cellulitis which Was Initially Suspected to Be a Trichilemmal Cyst

“…1 If DCS has spread to the entire occipital region, aggressive surgical treatment may be helpful in terms of patients' quality of life. 6 As for nonsurgical treatments, isotretinoin, corticosteroids, doxycycline, minocycline, and adalimumab have all been employed. 3 However, all of these drugs are considered unsuitable for young women, as they can be pregnant.…”

“…1 If DCS has spread to the entire occipital region, aggressive surgical treatment may be helpful in terms of patients’ quality of life. 6…”

Demographic and Histopathological Evaluation in 71 Patients Diagnosed with Dissecting Cellulitis of the Scalp

“…Te clinical presentation is painful nodules and abscesses, and in the late stage, sinuses with interconnecting draining pathways may occur [5,6,9,10]. Te severity of the disease depends on the number of nodules, abscesses, sinus tracts, scars, and the involvement of an isolated scalp area or the entire calvaria [7,11]. In the early stages, the patient may experience hair regrowth spontaneously or only with treatment [10].…”

Successful treatment of dissecting cellulitis with certolizumab pegol in a pregnant patient

“…It is considered one of the follicular occlusion tetrads, along with hidradenitis suppurativa (HS), acne conglobata, and pilonidal cysts. 1 , 2 …”

“…However, DCS cases in other ethnic groups, females, and younger patients have also been reported. 1 , 2 …”