A Case of Dissecting Cellulitis of the Scalp, Hidradenitis Suppurativa, and Conglobate Acne Successfully Treated with Secukinumab

Abstract

Introduction: Dissecting cellulitis of the scalp (DCS) is a neutrophilic scarring alopecia typically presenting with pustules and fluctuant nodules, followed by suppuration and sinus tract formation. DCS is often associated with other diseases, such as hidradenitis suppurativa (HS) and conglobate acne (CA) which share similar pathogenetic mechanisms.

Case presentation: The authors report the case of a patient affected by a severe form of DCS, HS, and CA of the face. Previous treatments with isotretinoin, antibiotics, and adalimumab did not have a considerable efficacy. Off-label treatment with secukinumab showed a gradual improvement in the clinical presentation bringing to a reduction in the number of HS lesions and to an almost complete resolution of the inflammatory manifestations of DCS.

Conclusion: Management of DCS is challenging and is typically based on retinoids which are considered the first line of treatment. The efficacy of biologic drugs, especially TNFα inhibitors, in severe and relapsing forms of DCS has been reported in recent literature. To our knowledge, only one case of isolated DCS treated with secukinumab is reported. No cases of concomitant DCS and HS, treated with this type of IL-17 inhibitor, have been described.

Keywords: Acne; Cicatricial alopecia; Hidradenitis suppurativa; Secukinumab.

Fig. 1.

Clinical presentation of nodules, abscesses, and sinus tracts on axillae (a), temporal areas (b), and cheeks (c) before therapy with secukinumab.

Fig. 2.

Clinical presentation of axillae (a), temporal areas (b), and cheeks (c) 1 year after starting therapy with secukinumab.