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Review
. 2023 Nov;13(11):2487-2526.
doi: 10.1007/s13555-023-01018-7. Epub 2023 Sep 22.

Treatments for Dissecting Cellulitis of the Scalp: A Systematic Review and Treatment Algorithm

Rahul Masson  1 , Charlotte Y Jeong  2 , Elaine Ma  1 , Ashley B Crew  3 , Natalie M Fragoso  4 , Vivian Y Shi  5 , Jennifer L Hsiao  6
Affiliations
Review

Treatments for Dissecting Cellulitis of the Scalp: A Systematic Review and Treatment Algorithm

Rahul Masson et al. Dermatol Ther (Heidelb). 2023 Nov.

Abstract

Background: Dissecting cellulitis of the scalp (DCS) is a chronic inflammatory skin condition characterized by abscesses, nodules, fistulas, and scarring alopecia. Management of this oftentimes debilitating dermatosis can be challenging due to its recalcitrant nature. There is limited data regarding the efficacy of treatment options for DCS.

Objective: The aim of this study was to conduct a systematic review of the literature to explore the efficacy and safety of reported DCS treatments.

Methods: In October 2022, MEDLINE and EMBASE databases were searched for articles on treatments for DCS. Studies that contained outcome efficacy data for DCS treatments were included. Reviews, conference abstracts, meta-analyses, commentaries, non-relevant articles, and articles with no full-text available were excluded. Data extraction was performed by two independent reviewers.

Results: A total of 110 relevant articles with 417 patients were identified. A majority of studies (86.4%) were case reports or series. Treatment options included systemic antibiotics, oral retinoids, biologics, procedural treatments, combination agents, and topical treatments. Oral retinoids and photodynamic therapy were the most extensively studied medical and procedural interventions, respectively.

Conclusion: Overall, randomized controlled trials are needed to evaluate various treatment regimens for DCS and provide patients with a robust, evidence-based approach to therapy.

Keywords: Dissecting cellulitis of the scalp; Medical; Procedural; Systematic review; Systemic; Therapy; Treatment.

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Conflict of interest statement

Natalie M. Fragoso is an investigator for Acelyrin. Vivian Y. Shi is on the board of directors for the Hidradenitis Suppurativa Foundation (HSF), is an advisor for the National Eczema Association, is a stock shareholder of Learn Health, and has served as an advisory board member, investigator, speaker, and/or received research funding from Sanofi Genzyme, Regeneron, AbbVie, Genentech, Eli Lilly, Novartis, SUN Pharma, LEO Pharma, Pfizer, Incyte, Boehringer Ingelheim, Alumis Aristea Therapeutics, Menlo Therapeutics, Dermira, Burt’s Bees, Galderma, Kiniksa, UCB, Target-PharmaSolutions, Altus Lab/cQuell, MYOR, Polyfins Technology, GpSkin, and Skin Actives Scientific. Jennifer L. Hsiao is on the board of directors for the Hidradenitis Suppurativa Foundation, has served as a consultant for Aclaris, Boehringer Ingelheim, Novartis, and UCB, and has served as a consultant and speaker for AbbVie. Rahul Masson, Charlotte Y. Jeong, Elaine Ma, and Ashley B. Crew report no conflicts of interest.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
Dissecting cellulitis of the scalp treatment algorithm.†BID, twice a day; CO2, carbon dioxide; IL, interleukin; ILTAC, intralesional triamcinolone; kg; kilogram; mg, milligram; ND:YAG, neodymium-doped yttrium–aluminum–garnet; q, every; QD, daily. †Algorithm developed on the basis of systematic review and authors’ expert opinion. *Other systemic antibiotic therapy to consider if patient fails or is intolerant to tetracyclines: dapsone, azithromycin, trimethoprim–sulfamethoxazole, cephalexin. **Consider oral prednisone 0.5–1 mg/kg for a 2–4 week taper as needed for severe flares and as a bridge to longer term therapy. Figure created with biorender.com
See this image and copyright information in PMC

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