What Is Dissecting Cellulitis?
Dissecting cellulitis of the scalp is a chronic inflammatory condition that damages hair follicles and can lead to permanent hair loss. It is considered a form of scarring alopecia, meaning that once the hair follicles are destroyed, the hair cannot grow back in those areas.
This condition is sometimes referred to by other medical names, including:
-
Dissecting folliculitis
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Perifolliculitis capitis abscedens et suffodiens
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Hoffman disease
Dissecting cellulitis typically begins with inflamed hair follicles that become blocked and rupture. This leads to painful lumps on the scalp that may drain fluid or pus. Over time, inflammation can destroy hair follicles and leave areas of permanent scarring and baldness.
Who Gets Dissecting Cellulitis?
Dissecting cellulitis most commonly affects young adult men, particularly men of African descent or men with tightly curled hair. It usually develops between the ages of 20 and 40, although it can occur at other ages and in women.
Because this condition disproportionately affects men with textured hair, it is an important cause of scarring hair loss in men of color.
Dissecting cellulitis may also occur alongside other conditions involving blocked hair follicles, including:
- Hidradenitis suppurativa
- Severe acne (acne conglobata)
- Pilonidal cysts
These conditions are sometimes grouped together as part of the follicular occlusion syndrome.
What Causes Dissecting Cellulitis?
The exact cause of dissecting cellulitis is not fully understood. However, the condition appears to begin with blockage of hair follicles.
The general process is thought to involve:
- Plugging of the hair follicle with keratin
- Inflammation and swelling of the follicle
- Rupture of the follicle
- Development of painful nodules and abscesses
- Formation of draining tracts under the skin
- Permanent destruction of hair follicles
Once follicles are destroyed, scarring hair loss can occur.
What Are the Symptoms of Dissecting Cellulitis?
The symptoms usually begin gradually and may worsen over time.
Common symptoms include:
- Painful bumps or nodules on the scalp
- Areas of swelling that feel soft or “boggy”
- Drainage of pus or fluid
- Crusting or scabbing of the scalp
- Patches of hair loss
- Scarring of the scalp
The condition most often affects the top and back of the scalp.
In more severe cases, the nodules may connect under the skin, forming sinus tracts, which can lead to ongoing inflammation and drainage
How Is Dissecting Cellulitis Diagnosed?
Dermatologists can often diagnose dissecting cellulitis by examining the scalp and evaluating the pattern of inflammation and hair loss.
In some cases, additional tests may be recommended, such as:
- Scalp biopsy
- Bacterial cultures
- Evaluation for other conditions that cause scarring alopecia
Early diagnosis is important because treatment can help reduce inflammation and limit permanent hair loss.
Treatment for Dissecting Cellulitis
Dissecting cellulitis is a chronic condition, but treatment can help control symptoms and prevent progression.
Treatment options may include:
Medications
- Oral antibiotics to reduce inflammation and infection
- Corticosteroid injections into inflamed areas
- Oral retinoids such as isotretinoin
- Anti-inflammatory medications
- Biologic medications in severe cases
Procedures
- Drainage of painful abscesses
- Laser treatments to reduce follicular inflammation
- Surgical removal of severely affected areas in advanced disease
Because the condition can vary significantly from person to person, treatment is usually customized to the patient’s symptoms and severity.
Why Early Treatment Matters
Without treatment, dissecting cellulitis can lead to:
- Permanent scarring hair loss
- Chronic inflammation and drainage
- Large areas of scalp damage
Early care by a dermatologist can help reduce inflammation, control flare-ups, and protect remaining hair follicles.
When Should You See a Dermatologist?
You should see a dermatologist if you have:
- Painful bumps or lumps on the scalp
- Drainage or crusting lesions
- Areas of hair loss associated with scalp inflammation
- Recurrent scalp infections
These symptoms are not normal dandruff or simple folliculitis and may represent a form of scarring alopecia that requires specialized treatment.
Dissecting Cellulitis Treatment in New York City
At Aglow Dermatology, Dr. Dina D. Strachan evaluates and treats complex hair and scalp disorders, including:
- Dissecting cellulitis
- Folliculitis decalvans
- Central centrifugal cicatricial alopecia (CCCA)
- Alopecia areata
- Androgenetic alopecia and more!
If you are experiencing painful scalp bumps, drainage, or unexplained hair loss, early evaluation may help prevent permanent scarring. Schedule a consultation here.