Poster Presentation Australasian Society for Dermatology Research Annual Scientific Meeting 2024

Dissecting cellulitis of the scalp in a paediatric male (#57)

Meryl T Thomas 1 2 , Valerie Yii 1 , Rod Sinclair 1 3
  1. Sinclair DIRECT, Dermatology Investigational Research, Education and Clinical Trials Centre, Melbourne, Victoria, Australia
  2. Monash School of Medicine, Monash University, Clayton, Victoria, Australia
  3. Epworth Healthcare, Richmond, Victoria, Australia

Background:

Dissecting cellulitis of the scalp (DCS) is an inflammatory dermatosis of the scalp1, characterised by suppurative and often interconnected nodules that can cause cicatricial alopecia.2 Lesions are most frequently seen on the vertex of the scalp.3 DCS is most common in African-American men between the ages of twenty and forty.1 To the best of our knowledge, this is the youngest reported case of DCS in a male. Treatment is largely empirical as there have been no randomised controlled-trials for this rare condition. Most patients experience improvement or complete remission on isotretinoin.2 For DCS resistant to oral retinoids, biologic agents can be considered.4 Severe cases may require wide local excision of the affected area, resulting in permanent alopecia.1

Observations:

A 13-year-old boy presented with alopecia and scalp nodules, refractory to doxycycline, clindamycin and topical steroids. There was no significant past medical history. He has a maternal uncle with alopecia areata. Examination revealed multiple tender, erythematous nodules overlying the areas of alopecia. In addition, there were a few scattered pustules. Swab from a scalp pustule did not show any bacterial or fungal growth. The clinical diagnosis was dissecting cellulitis of the scalp. The patient was commenced on isotretinoin 10 mg daily (0.20 mg/kg), sublingual minoxidil 0.45 mg twice daily, oral prednisolone 25 mg daily for two weeks then 12.5 mg daily for four weeks, and antiseptic shampoo. Four weeks later, the inflammatory scalp lesions were flattened; no new nodules or pustules were seen. There was also significant hair regrowth.

Key message:

Though uncommon in adolescents, DCS should be considered in paediatric patients with scalp nodules and patchy hair loss. Tinea capitis should be ruled out before a diagnosis of DCS is made. Minoxidil should be considered as part of the treatment regime to accelerate hair growth, alongside oral isotretinoin.

  1. Nussbaum D, Desai S, Nelson K, Saardi K, Friedman A. An Up-to-Date Approach to the Management of Dissecting Cellulitis. J Drugs Dermatol. 2022;21(7):800-2.
  2. Guo W, Zhu C, Stevens G, Silverstein D. Analyzing the Efficacy of Isotretinoin in Treating Dissecting Cellulitis: A Literature Review and Meta-Analysis. Drugs R D. 2021;21(1):29-37.
  3. Lee C-N, Chen W, Hsu C-K, Weng T-T, Lee JY-Y, Yang C-C. Dissecting folliculitis (dissecting cellulitis) of the scalp: a 66-patient case series and proposal of classification. JDDG: Journal der Deutschen Dermatologischen Gesellschaft. 2018;16(10):1219-26.
  4. Masson R, Jeong CY, Ma E, Crew AB, Fragoso NM, Shi VY, et al. Treatments for Dissecting Cellulitis of the Scalp: A Systematic Review and Treatment Algorithm. Dermatol Ther (Heidelb). 2023;13(11):2487-526.