A 25-Year-Old Man with Suppurative Nodules of the Scalp

Abstract

Dissecting cellulitis is a chronic inflammatory disease classified as a primary neutrophilic cicatricial alopecia. The precise pathogenesis of dissecting cellulitis is unknown. However the role of hyperkeratosis, follicular occlusion and subsequent inflammation has been described. Dissecting cellulitis occurs almost exclusively in young men of African descent. Clinically, multiple firm, violaceous papules which coalesce to form plaques and nodules are observed. Abscesses and sinus tracts with pustular or hemorrhagic fluid are also presented. Hypertrophic scars and keloids may appear. The vertex and the occipital area are most commonly affected. The course of the disease is usually chronic with periodic flares. Diagnosis of dissecting cellulitis is mainly based on the clinical and histopathological features. Trichoscopy can be useful to avoid scalp biopsy. The treatment options include topical or intralesional corticosteroids, topical antibiotics, systemic antibiotics (ciprofloxacin, clindamycin, rifampin, and trimethoprim/sulfamethaxole) and isotretinoin. Systemic corticosteroids and tumor necrosis factor inhibitors may be also useful.