Large areas of scarring and alopecia.

DISSECTING CELLULITIS OF THE SCALP

Dissecting cellulitis of the scalp (DCS) (also known as perifolliculitis capitis absedens et suffodiens) is a chronic inflammatory condition of the scalp that often leads to significant scarring. Strictly speaking, this condition is not infectious, however, in practice, secondary infection by e.g. Staphylococcus is common. DCS may be associated with two other diseases that altogether make up the follicular occlusion triad (hidradenitis superativa and acne conglobata). Alopecia-associated pseudocyst of the scalp may be a precursor.

• Typically, DCS is diagnosed in men aged between 20 and 40 years with skin type IV and above.
• Inquiry should be made about oil exposure, e.g. at work as this can trigger. One study found going to a gym and anabolic steroid use can trigger DC.

A spreading alopetic area with peripheral pustules is characteristic. Crust, pus and inflammatory, draining nodules are typical. Deep, painful nodules, abscesses, and sinus tracts may develop which can result in permanent hair loss.

Disecting Cellulitis of the Scalp vs. Folliculitis Decalvans (FD)

While both FD and DCS/PCAS cause scarring alopecia, DCS is more likely to present with large nodules and abscesses, while FD is more likely to have pustules and tufted hair.

RegionalDerm

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