Dissecting cellulitis of the scalp (DCS) is a chronic inflammatory disease of scalp hair follicles manifesting as multiple painful nodules and abscesses that interconnect via sinus tracts. The disease tends to run a progressive course that eventually results in scarring alopecia. The condition is thought to represent a follicular occlusion disorder. Sebaceous and keratinous material within dilated pilosebaceous units accumulates until follicles burst, with subsequent neutrophilic inflammatory reaction and abscess formation. Treatment remains unsatisfactory. While oral antibiotics, intralesional corticosteroids, isotretinoin, or dapsone are insufficient, in this case series the inflammation responsible for scarifying tissue destruction was directly targeted by means of the tumor necrosis factor antagonist adalimumab.
Clinical signs of inflammation as well as burden of disease measured by a score of 0 to 10 (P < .04) was reduced rapidly by adalimumab. Histopathologic characteristics demonstrated marked improvement of inflammation, despite persistence of underlying structural disease. Relapse was observed following discontinuation of adalimumab.
Adalimumab is effective for treatment of DCS. Relapse on discontinuation of therapy can be expected depending on persisting structural disease. Continuous treatment or combined surgical resection of involved areas could be necessary for definitive resolution of disease.Published online March 15, 2010 (doi:10.1001/archdermatol.2010.16).