Dissecting cellulitis of the scalp (DCS) is a chronic inflammatory disorder characterized by painful nodules, draining sinus tracts, and scarring alopecia. Research on treatment is limited, and responses vary between patients.
This retrospective cohort included 106 patients with DCS seen between 2013–2023 at Keck Medicine of USC and affiliated county clinics. Most patients were male (91.5%); 21.8% identified as Black and 57.7% as Hispanic. Hidradenitis suppurativa (HS), a chronic skin condition that causes painful bumps and tunnels in skin folds, was present in 24.5% of patients evaluated. Treatment histories and clinical responses were reviewed.
Treatment patterns and outcomes
Commonly used treatments were single oral antibiotics (90.6%), topical therapies (87.7%), intralesional corticosteroids (48.1%), oral retinoids (26.4%), oral antibiotics (9.4%), IV antibiotics (6.6%), surgical excision (6.6%), and hormonal modulators (1.9%). Biologic medications including infliximab 4/4, secukinumab 1/1, adalimumab 10/12 had higher response rates but were used less frequently (11.3%).
Intralesional corticosteroids were highly effective (49/50, 98%), as were topical clindamycin (58/60, 96.7%) and corticosteroids (44/46, 95.7%). Ketoconazole shampoo was effective in 17 of 21 patients (81.0%). Retinoid responses were more modest: isotretinoin improved 14 of 24 patients (58.3%), while acitretin improved 3 of 4 (75%), a potentially valuable option given the male predominance of DCS. Rifampin showed limited benefit, either alone (1/3) or in combination with clindamycin (1/3), whereas clindamycin monotherapy improved 9 of 10 patients.
Limitations and implications
The study was limited by its single-center design, small subgroup sizes, reliance on physician versus patient-reported improvement, and absence of standardized severity scoring. The authors highlight the need for validated outcome measures and randomized controlled trials.
Notably, patients with more severe or treatment-resistant disease may have been prescribed advanced oral agents such as isotretinoin. However, their comparatively lower response rates likely reflect the underlying severity of their condition rather than a lack of efficacy of the therapy itself.
Conclusion
In this study, infliximab, secukinumab, adalimumab, IV antibiotics, surgical excision, intralesional corticosteroids, and select topical or oral antibiotic regimens were associated with the highest response rates. Isotretinoin showed modest benefit, while acitretin, clindamycin monotherapy, and cephalexin plus TMP-SMX emerged as promising options. Until further information is
available, a treatment framework modeled on hidradenitis suppurativa management may provide the most practical guidance for clinicians.
Article Review Completed by Keyarah Grullon, Research Associate at MGB Dermatology. Reviewed by Dr. Kathie Huang, MD, FAAD.
Reference
Ghanshani R, Chung CS, Park SE, et al. Dissecting cellulitis of the scalp: Treatment responses in a retrospective cohort study. J Am Acad Dermatol. Published online 2025. doi:10.1016/j.jaad.2025.06.005
