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

The follicular occlusion tetrad complex encompasses several entities (hidradenitis suppurativa, acne conglobata, dissecting cellulitis of the scalp, and pilonidal cyst) that share common clinical features, risk factors, and pathophysiology. Follicular occlusion is a crucial triggering mechanism in the etiology in each of these disorders, leading to development of distinctive skin lesions such as deep-seated nodules, abscesses, comedones, and draining sinuses, often with accompanying scarring. Despite the fact that the follicular occlusion tetrad components manifest multiple similarities, they also exhibit many differences among themselves and require individual approaches and treatment.

Dissecting cellulitis of the scalp (DCS) is a rare recurrent inflammatory disease of unknown etiology. Ideal treatment of DCS remains unclear. We treated DCS with 2940-nm erbium Yttrium-aluminum-garnet (YAG) laser in 12 patients and assessed the efficacy by Physicians Global Assessment (PGA), number of inflammatory nodules, abscesses, and area of alopecia. After a mean treating session of 2.2 months, 10 patients reached PGA 0 (initial PGA 1) or 1 (initial PGA ≥2). At the end of treatment, there was 84%, 100%, and 74% regression in nodules, abscesses, and alopecia area, respectively. No severe adverse effect was observed. 2940-nm erbium: YAG laser may be an effective and safe way to treat DCS resistant to other therapies.

Alopecic and aseptic nodules of the scalp (AANS) and dissecting cellulitis of the scalp (DCS) are rare, closely related conditions of young men that exclusively affect the hair-bearing scalp. We describe a 9-year-old boy who presented with a 6-year history of chronically relapsing, sterile, partially scarring nodules of the scalp and facial skin. Histopathology revealed mixed inflammatory infiltrates consisting of neutrophils, macrophages, lymphocytes, and plasma cells in the deep dermis, consistent with the morphological pattern of suppurative, partly granulomatous dermatitis. The present atypical case is characterized by prepubertal onset and facial involvement which, to our knowledge, has not yet been described before, may be included in the spectrum of \"typical\" AANS and \"typical\" DCS.

Dissecting cellulitis of the scalp (DCS) is a rare skin disease and understudied. The aim of the study was to collect the demographic, clinical features and laboratory tests of patients with DCS in a dermatology outpatient clinic. A cross-sectional study was conducted in a department of dermatology in Beijing. Patients whose diagnoses have included DCS were selected from July 2021 to December 2021. DCS patients were stratified according to whether they were follicular occlusion triad (FOT) or not. There were 169 patients with DCS included. All 169 patients were male, and the median patient age was 32 years. The most common comorbidities in this study were seborrheic dermatitis (10.65%). Over 1/3 of patients had elevated white blood cell (WBC) and neutrophil counts, and 12 of 18 patients had dyslipidemia. CD8+ T cell counts increased in 15 of 26 patients while CD4+ T/CD8+ T ratios were all normal. DCS mainly affects men in their thirties. More research about DCS is needed to clarify the clinical significance of laboratory tests.

BACKGROUND: Dissecting cellulitis of the scalp (DCS) is a rare but distinctive, chronic suppurative condition, and the treatment is a therapeutic challenge. Recently, treatment of DCS with 5-aminolaevulinic acid photodynamic therapy (ALA-PDT) has been considered as a potential option.
OBJECTIVE: To evaluate the efficacy and safety of 20% ALA-PDT pretreated by fire needle in the treatment of DCS.
METHODS: Topical 20% ALA-PDT with fire needle intervention as a pretreatment, was applied to six patients with DCS. All patients completed three sessions treatment at an interval of ten days. They were assessed for the efficacy at the baseline and on ten days after each treatment. According to the reduction of lesions and the improvements of patients\' symptoms after each session, the objective assessment of therapeutic effect was divided into four grades. The adverse effects were recorded.
RESULTS: A total of six male patients were enrolled in our study. After three sessions of ALA-PDT, among them, three patients recovered, two patients achieved significant improvement and one patient achieved partial response.Patient 4 (Pt.4) relapsed at 6-month follow-up. Pt.1 and Pt.6. maintained complete response after one year follow-up. We also found that the clearance rate of the popular/nodular and cyst/abscess was much higher than sinus.
CONCLUSIONS: 20% ALA-PDT pretreated by fire needle could be an effective, minimally-invasive, safe method for DCS patients. Lesion in the early stages have a better response than sinus.

BACKGROUND: Different therapies have been used for dissecting cellulitis of the scalp (DCS) with poor results. Topical 5-aminolaevulinic acid photodynamic therapy (ALA-PDT) is effective for many inflammatory skin diseases.
OBJECTIVE: To evaluate the efficacy and safety of fire micro-needling plus 5% ALA-PDT on DCS.
METHODS: Forty-two male DCS patients were enrolled and treated by four sessions of fire micro-needling plus 5% ALA-PDT (occlusion time: 3 h, 100 mW/cm2 for 20-32 min, 633 ± 10 nm LED) with an interval of 1-2 weeks. The reduction of lesions was evaluated at each follow-up visit. The patients` symptoms were evaluated by Dermatology Life Quality Index (DLQI). All of the side effects were recorded.
RESULTS: Forty-one DCS patients finished the treatments and the marked effective rate (MER) reached 65.85%. Ten patients (24.39%) were cured and 17 patients (41.46%) achieved excellent improvement. The median of lesion numbers decreased significantly from 25 to 7 (p < 0.001) with DLQI from 13 to 2 (p < 0.001). Although all the ten cured patients had a relapse during the 12-month follow-up, 5/10 patients had a remission of more than 6 months. All the patients tolerated PDT well with mild adverse effects.
CONCLUSIONS: Fire micro-needling plus 5% ALA-PDT is effective for Chinese male DCS patients without the need to take systemic drugs.

BACKGROUND: Medicinal therapies such as systemic retinoids and antibiotics have shown efficacy in the treatment of dissecting cellulitis of the scalp (DCS), but refractory cases are common. 5-Aminolevulinic acid photodynamic therapy (ALA-PDT) has been successfully used in medicine-resistant cases in recent years.
METHODS: A total of 12 patients who received ALA-PDT in addition to formally failed medicinal therapies were interviewed by telephone regarding improvement of symptoms, satisfaction, and side effects.
RESULTS: Overall, 58.3 % patients achieved greater than 50 % improvement of at least one symptom, and 16.7 % had little improvement for any symptom. The proportion of patients who had greater than 50 % improvement for pain, pruritus, swelling and suppuration were 36.4 %, 66.7 %, 33.3 % and 58.3 % respectively. 41.7 % patients were either satisfied or very satisfied with the ALA-PDT. The side effects were mainly pain and crusting that were mostly mild and recovered quickly.
CONCLUSIONS: ALA-PDT was safe and partially effective in reducing DCS symptoms as an adjunct to systemic medicinal therapies.

BACKGROUND: Hidradenitis suppurativa (HS) is associated with comorbidities that contribute to poor health, impaired life quality, and mortality risk.
OBJECTIVE: To provide evidence-based screening recommendations for comorbidities linked to HS.
METHODS: Systematic reviews were performed to summarize evidence on the prevalence and incidence of 30 comorbidities in patients with HS relative to the general population. The screening recommendation for each comorbidity was informed by the consistency and quality of existing studies, disease prevalence, and magnitude of association, as well as benefits, harms, and feasibility of screening. The level of evidence and strength of corresponding screening recommendation were graded by using the Strength of Recommendation Taxonomy (SORT) criteria.
RESULTS: Screening is recommended for the following comorbidities: acne, dissecting cellulitis of the scalp, pilonidal disease, pyoderma gangrenosum, depression, generalized anxiety disorder, suicide, smoking, substance use disorder, polycystic ovary syndrome, obesity, dyslipidemia, diabetes mellitus, metabolic syndrome, hypertension, cardiovascular disease, inflammatory bowel disease, spondyloarthritis, and sexual dysfunction. It is also recommended to screen patients with Down syndrome for HS. The decision to screen for specific comorbidities may vary with patient risk factors. The role of the dermatologist in screening varies according to comorbidity.
CONCLUSIONS: Screening recommendations represent one component of a comprehensive care strategy.
CONCLUSIONS: Dermatologists should support screening efforts to identify comorbid conditions in HS.