Patient presentation and diagnosis
A 47-year-old man presented with a 7-month history of a painful rash on his head that had not improved with multiple courses of oral antimicrobial agents. On examination, multiple tender, boggy, and erythematous nodules with scant purulent and serosanguinous drainage were noted on the scalp vertex with overlying alopecia. A diagnosis of dissecting cellulitis of the scalp was made, which is characterized by suppurative nodules and patchy hair loss triggered by follicular occlusion.
Laboratory findings
The patient's white-cell count was normal, and laboratory studies including a fourth-generation human immunodeficiency virus test and a rapid plasma reagin test were negative.
Treatment and follow-up
Topical glucocorticoids and oral doxycycline were initiated, resulting in abatement of scalp drainage and swelling at the 4-week follow-up.
Associated conditions
Dissecting cellulitis of the scalp may be associated with other follicular occlusive disorders, such as acne conglobata, hidradenitis suppurativa, and pilonidal cysts, none of which were present in this patient.
Najjar, S. N., & Rezigh, A. B. (2023). Dissecting Cellulitis of the Scalp. New England Journal of Medicine, 388(17), 1608-1608.