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December 24, 2023

Dissecting Cellulitis: An Inflammatory Scalp Condition Leading to Scarring Alopecia

SOCAH Center

Dissecting Cellulitis (DC), also known as Perifolliculitis Capitis Abscedens et Suffodiens, is a distressing scalp condition associated with hair loss, specifically scarring alopecia. This inflammatory disorder predominantly affects individuals between the ages of 20 to 40 and is more commonly found in African Americans, followed by Hispanics and Caucasians. In this article, we will delve into the key aspects of DC, highlighting its symptoms, causes, diagnosis, and treatment options with a strong focus on alopecia and hair loss-related keywords.

Symptoms and Progression

DC typically commences with painful, inflamed hair follicles resembling acne-like bumps, predominantly in the crown of the scalp or posterior neck. Over time, these inflamed follicles progress into multiple boils that can connect beneath the skin, forming sinus tracts or canals, which often drain pus and/or blood.

At its most advanced stage, the affected scalp may feel soft and boggy to the touch, and pressure applied to one lesion may express pus at a distant lesion. The accumulated fluid under the skin exerts pressure on overlying hair follicles, ultimately destroying them and leading to permanent hair loss.

Diagnosis and Considerations

Diagnosing DC involves a clinical examination, often complemented by a scalp biopsy. It is essential to rule out other conditions that exhibit similar symptoms, such as acne conglobata and hidradenitis suppurativa, as these may co-occur due to blocked hair follicles triggering an exaggerated inflammatory response. Furthermore, differential diagnoses like pseudopelade of Brocq, tinea capitis, and folliculitis decalvans should also be excluded.

Causes and Contributing Factors

While DC’s exact cause remains elusive, it is important to emphasize that it is not caused by unclean clippers or poor haircuts. The condition is associated with blocked hair follicles that trigger an abnormal inflammatory response. Patients are advised that while haircuts are still possible, caution is required to minimize scalp trauma and irritation.

Treatment and Alopecia Prevention

Treating DC primarily focuses on halting the inflammatory process. Oral antibiotics are employed to address secondary infections and harness their anti-inflammatory properties. Steroid injections, when administered directly into the scalp, work similarly to reduce local inflammation. In severe cases, combination regimens may be prescribed. Laser hair removal and surgical interventions can significantly improve or completely resolve lesions. It is crucial to underscore the significance of healing chronic open wounds, as they can elevate the risk of skin cancer development in the affected area.


Dissecting Cellulitis is an inflammatory scalp condition that not only causes physical discomfort and psychological distress but can also result in scarring alopecia or permanent hair loss. Early diagnosis and prompt treatment are pivotal in preventing disease progression and alopecia. While the exact cause of DC remains unclear, maintaining healthy hair and scalp hygiene, and seeking professional guidance, can help mitigate the impact of this challenging condition. Understanding the link between DC and alopecia is crucial for those affected and their healthcare providers, to ensure effective management and improved outcomes.

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