Improvement of Recalcitrant Dissecting Cellulitis of the Scalp After a Trial of Upadacitinib

Abstract

Dissecting cellulitis of the scalp (DCS) is a rare condition characterized by painful inflammatory nodules and abscesses on the scalp, often leading to sinus tracts and scarring alopecia. We present a case of DCS in a 26-year-old male who experienced significant clinical improvement following a short course of upadacitinib, a Janus kinase (JAK) inhibitor. The patient received multiple standard treatments such as topical antimicrobials, oral antibiotics, corticosteroids, and intralesional triamcinolone injections, with limited success. However, following the initiation of upadacitinib, the patient reported reduced pain, pustular draining, and bleeding, with significantly improved quality of life. To our knowledge, there is currently a paucity of literature documenting the use of JAK inhibitors for DCS. This case aims to highlight the potential of JAK inhibitors as a therapy for refractory DCS, a condition with limited treatment options.

Keywords: dissecting cellulitis of scalp; follicular occlusion tetrad; folliculitis decalvans; hidradenitis suppurativa; jak inhibitor; upadacitinib.

Figure 1. Prior to the trial of upadacitinib

Posterior scalp with large pustules, nodules, and interconnected, firm, edematous sinus tracts that drain pus and blood, with an absence of hair growth.

Figure 2. After two months of upadacitinib

Posterior scalp with fewer pustules and smaller, less inflamed sinus tracts without pustular drainage or bleeding. Areas of prior inflammation now exhibit scarring.