Dissecting cellulitis of the scalp is a rare skin condition that causes hair loss, pain, and scarring. While there’s no cure, treatment may include oral and topical medications and antiseptic shampoos.
Dissecting cellulitis of the scalp (DCS) is a rare skin condition that typically affects young adult Black males. However, the condition can affect anyone regardless of age, race, or sex.
Also known as perifolliculitis capitis abscedens et suffodiens or Hoffman disease, DCS may be due to inflammation of blocked hair follicles.
DCS is a chronic condition that can be challenging to treat. In this article, we’ll provide information about its symptoms, causes, and treatments. We’ll also explain who’s most at risk and what your outlook with DCS may be.
DCS may worsen over the course of several months or years. At first, blocked hair follicles in DCS may turn into painful, raised lumps, primarily on the top of the head. Over time, the lumps may spread downward throughout the entire scalp.
Early onset symptoms include:
- painful, pus-filled lumps and lesions
- secondary bacterial infections (folliculitis)
- patches of hair loss
Less common early symptoms may include:
- fever
- tender or swollen lymph nodes
Later-stage symptoms may include:
Blocked hair follicles cause DCS. The underlying reason why this occurs in some people but not others is unknown.
Once blocked, hair follicles swell and rupture. This releases keratin, causing significant inflammation in the scalp. Secondary infections, scarring, and hair loss are common results.
DCS can affect people of any sex or race. However, it most commonly affects Black males ages 20–40.
Researchers in a 2022 study also found a link between DCS and smoking.
Follicular occlusion tetrad
DCS may coexist with other conditions that cause hair follicle blockages, ruptures, and inflammation. When they occur along with DCS, the below combination of conditions is known as the
- hidradenitis suppurativa, boils and cysts that form in the folds of your body
- acne conglobate, a severe type of acne
- pilonidal sinus, an infected cyst located at the base of the spine
Other related conditions
Inflammation in other parts of your body, such as the joints (arthritis) and bones, may accompany DCS. Other common comorbidities
- keratitis
- keratitis-ichthyosis-deafness syndrome
- pyoderma gangrenosum
- osteomyelitis
- Crohn’s disease (rarely)
A specialist, such as a dermatologist, can diagnose DCS visually during a physical exam.
They may take samples of pus or hair to check for underlying infections that might be causing your symptoms. These samples can undergo analysis under a microscope in a laboratory.
In some instances, a doctor may also recommend a scalp biopsy. This procedure can take place in a specialist’s office or other outpatient setting.
During the biopsy, a healthcare professional will remove one or more small samples of scalp tissue and hair follicles to send to a lab for analysis. They’ll administer a local anesthetic before the biopsy to reduce any discomfort you might feel.
DCS is an incurable chronic condition. Still, treatments can effectively manage active symptoms.
Treating DCS usually involves strategies for limiting hair loss, pain, and oozing from sores. A healthcare professional will recommend you stop using oil-based products on your scalp and may suggest eliminating hair products that contain chemical irritants.
Medications and products used to treat DCS include:
- topical and oral steroids to reduce inflammation
- topical and oral antibiotics to fight infection
- antiseptic shampoos and rinses to reduce the presence of bacteria on the scalp
- topical retinoids to reduce hair follicle blockage
- oral retinoids to combat severe acne and suppress the action of sebaceous (oil) glands in the scalp
In some instances, you may administer steroids directly into your scalp to reduce severe inflammation.
If you have large, painful abscesses, a doctor may surgically remove or drain them.
With DCS, you may experience periods of remission when you have no symptoms, followed by relapses. A healthcare professional may recommend keeping up with preventive treatments, such as antiseptic scalp rinses, even when you don’t have symptoms.
Medical treatments are highly valuable for managing symptoms like pain, irritation, and oozing. Starting treatment early may also help reduce hair loss. However, hair loss and scarring are common long-term results of DCS.
DCS is a type of scarring (cicatricial) alopecia. Joining a support group of people with these types of conditions may provide support and ongoing information that can make coping easier. Support groups are available through the National Alopecia Areata Foundation.
Is dissecting cellulitis deadly?
Dissecting cellulitis of the scalp is not a fatal disease.
Can dissecting cellulitis of the scalp be cured?
DCS is chronic and incurable. Long periods of remission, followed by relapses when symptoms occur, may continue for years.
Is dissecting cellulitis of the scalp an autoimmune disease?
DCS and its causes are not fully understood. Currently, experts consider DCS an auto-inflammatory condition. Your immune system may play a role in its occurrence, but scientists have not definitively determined this.
DCS is a rare condition that causes painful lesions, scarring, and hair loss. This chronic condition is treatable but not curable. It most commonly affects young Black men, although anyone can get it, regardless of age, sex, or race.
