Monthly Archives: June 2024

What is Dissecting Cellulitis?

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What is Dissecting Cellulitis? Dissecting Cellulitis (DC), also known as Hoffman disease, is a chronic (long-term) inflammatory scalp disorder that causes abscesses and keloids that lead to patchy hair loss and cicatricial (scarring) alopecia (destruction of hair follicles).

Dissecting cellulitis is incurable; however, somebody can manage symptoms to reduce pain and provide comfort.

DC is part of the follicular occlusion triad, where three diseases occur simultaneously. The other inflammatory diseases are acne conglobate (nodulocystic acne) and hidradenitis suppurativa (acne inversa).

The disease is most prominent in young adult black males but can, however, affect people of all races, ages, and sex.

What Causes Dissecting Cellulitis?

Specialists are working to determine the main cause of DC and establish why it affects some people and not others.

In this disorder, blocked hair follicles swell up and eventually rupture, causing inflammation underneath the skin.

Secondary Infection

The pus formed in the scalp following the follicle bursts becomes infected with bacteria over time, leading to further surface infections, hair loss, and scarring.

DC is often attributed as hereditary, but the disease rarely occurs in multiple family members. A small number of patients from the same family have experienced DC in the past, which leaves room for the assumption that genes play a role in the disease.  

Symptoms of Dissecting Cellulitis

DC, which starts as blocked hair follicles, worsens with time, with various signs and symptoms manifesting at the onset and later stages of the disease if not treated on time.

Early Symptoms

The most common onset symptoms include:

  • Swollen pimples on the scalp
  • Pus-filled painful lesions
  • Hair loss patches

Symptoms noticed in fewer cases:

  • Fever and swollen lymph nodes

Late Symptoms

  • Bleeding lesions
  • Permanent hair loss (fails to grow back after homecare treatments)
  • Wormlike skin fold between lesions
  • Scarring

If you exhibit the above symptoms, it is essential to seek immediate dermatology consultation, as they may indicate DC disease.

How is Dissecting Cellulitis Diagnosed?

Dermatologists usually diagnose DC through physical examinations of the scalp or infected areas. To further ascertain a DC diagnosis, they may swab pus (if the symptoms are at a later stage) or take scalp biopsies for histologic analysis.

Consult certified specialists and explain your symptoms in detail to avoid a misdiagnosis. 

What Does it Look Like?

A patient with a very severe case of dissecting cellulitis. He is currently receiving laser treatment under the care of Dr. Umar to manage symptoms.

What Treatments Are Available for Dissecting Cellulitis?

Once diagnosed, there are several recommended approaches to treating DC. As an incurable chronic condition, strategies have been put in place to manage active symptoms such as pain, hair loss, and lesions.

Medications 

There are three kinds of supplements used to manage DC:

  • Antibiotic oral supplements to fight infection. It is often recommended for long-term use to prevent relapse.
  • Steroid supplements are used in the short term to manage inflammation. They should be avoided in the long run to prevent severe side effects.
  • Oral retinoids help reduce follicle blockage and reduce acne. Retinoids cannot be purchased over the counter. Patients require a prescription from a certified dermatologist.

WARNING: Pregnant mothers are advised to refrain from retinoid use, which may cause extensive damage to the unborn child.

Topical Steroids

These are substances applied directly to the affected areas to reduce scalp inflammation. Examples include gels, lotions, ointments, and creams. These can be combined with topical antimicrobials and antiseptic scalp washes to reduce bacterial levels.

Surgery

Specialists may surgically drain large boils or painful abscesses to manage them by excising. Additionally, they can cut open the inflamed areas.

Surgical removal of the entire scalp skin is an extreme procedure and could be one of the most effective methods to manage DC. However, this procedure is for specific patients with severe cases. If the patient requests it, the doctor may follow other treatment methods for better results. 

Note: This exercise may leave scarring.

Other Treatments

  • Laser hair removal may lead to permanent hair loss.
  • Laser treatment to smoothen the scalp.
  • Radiation. 
  • Light treatment (photodynamic therapy). The procedure is slightly painful and might cause crusting. 
  • Steroid Injections are administered directly to affected areas. They are a painful procedure but have fewer side effects than steroid tablets.

Self-Care

  • Avoid smoking or tobacco use. Research findings have linked tobacco to cause DC.
  • Follow instructions and medications as directed.
  • Use medically approved products on your hair and scalp.
  • Maintain a normal, healthy diet.
  • Do regular check-ups with your specialist. 

A severe case of Dissecting Cellulitis (DC)

Dissecting Cellulitis (DC) and Acne Keloidalis Nuchae (AKN)

Dissecting Cellulitis can, in rare cases, coexist with other scalp and hair disorders.

Acne Keloidalis Nuchae, also known as AKN, is a skin disorder characterized by small or large bumps, often on the back of the head. Although common in males of African-American ethnicity, AKN can also affect people of other races.

AKN is often mistaken or misdiagnosed as razor bumps or keloidal conditions. It is far worse if left untreated. Use this link to ensure you get a diagnosis from a board-certified dermatologist like Dr. Sanusi Umar: https://dru.com/hair-free-consultation/. 

Some patients with severe scalp conditions may exhibit symptoms of both DC, AKN, and CVG (cutis verticis gyrata, a rare disorder common in males, characterized by deep skin folds on the scalp) due to overlapping risk factors. 

Additionally, multifaceted treatment is applied to ensure DC, AKN, and CVG are managed effectively. 

A patient with severe cutis verticis gyrata (CVG), acne keloidalis nuchae (AKN), and dissecting cellulitis (DC) conditions. He is currently receiving treatment under the care of Dr. Umar to manage symptoms. Notice the small and large bumps at the back of his head and the furrow-like appearance on the center of the scalp.

 

Dissecting Cellulitis Frequently Asked Questions (FAQ)

Is Dissecting Cellulitis Fatal?

Dissecting Cellulitis is not a deadly disease.

Is Dissecting Cellulitis Contagious?

No. Dissecting Cellulitis is not contagious and cannot be passed from one person to another.

Is Dissecting Cellulitis Curable?

No. It is incurable but can be managed.

How Can I Treat Dissecting Cellulitis?

You can complete a free consultation for your scalp condition with board-certified dermatologist Dr. Sanusi Umar using this link: https://dru.com/hair-free-consultation/ or the free consultation button below.

FREE CONSULTATION

References

Hintze, J. M., Howard, B. E., Donald, C. B., & Hayden, R. E. (2016). Surgical Management and Reconstruction of Hoffman’s Disease (Dissecting Cellulitis of the Scalp). Case Reports in Surgery, 2016, 1–4. https://doi.org/10.1155/2016/2123037

Tran, A. X., Lefante, J. J., & Murina, A. (2022). Risk factors for dissecting cellulitis of the scalp: A case-control study. Journal of the American Academy of Dermatology, 86(4), 941–943. https://doi.org/10.1016/j.jaad.2021.03.076

What is Cutis Verticis Gyrata (CVG) or Bulldog Scalp Syndrome?

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What is cutis verticis gyrata (CVG)? CVG is a rare disorder common in males, characterized by deep skin folds on the scalp resembling those of the brain. Also known as the “bulldog scalp” syndrome, the disorder is classified into primary and secondary forms.

Primary Form

The primary form of bulldog scalp syndrome, or CVG, affects the vertex and occipital regions on the scalp, with folds running symmetrically in an anterior-posterior direction.

The two types are:

  •  Primary Essential CVG: This form is prevalent among young adults, especially postpubertal men. The cause is attributed to genetics and endocrine factors.
  •  Primary Non-essential CVG: Unlike the primary essential, the non-essential CVG is often associated with various abnormalities such as schizophrenia, epilepsy, retardation, ophthalmologic and cranial abnormalities.

Secondary Form

The secondary form of bulldog scalp syndrome, or CVG, is associated with inflammatory and underlying scalp diseases. These may include cutis laxa, syphilis, amyloidosis, intracranial aneurysms, and acromegaly. 

What Causes Cutis Verticis Gyrata (CVG)?

Little research on the disorder shows that the cause is still undetermined. Understanding the etiology of CVG shows that it is not an individual disease entry. It is a manifestation of diverse causes:

Hormonal: The post-puberty onset of CVG and the male dominance suggest that various hormones can cause the disorder.

Imbalances of the growth hormone (GH) in some cases may lead to acromegaly or other endocrine disorders, which affect the overall physical growth of the body.

Genetics:

Genetics is often linked to the primary non-essential CVG, where the form is associated with neurodevelopmental disorders like epilepsy and retardation, among other genetic syndromes such as Turner Syndrome and Acromegaly.

Chronic Inflammation: Persistent scalp infections with recurrent inflammations may affect the skin, developing CVG folds and ridges.

Symptoms of Cutis Verticis Gyrata (CVG)

Although CVG symptoms are distinctive and visible ridges and furrows, here are others to look out for:

Primary Symptoms

  • Ridges and Furrow: These are very noticeable from the onset, with soft folds varying in prominence and depth. The ridges and furrows grow gradually over time.
  • Thickened Skin: During the early stages, the skin on the scalp thickens and becomes sponge-like to the touch.

Secondary Symptoms

In the case of secondary CVG form, one might experience additional symptoms related to underlying disorders or conditions:

  •   Hair loss or thinning on the affected areas.
  •   Discomfort and itching
  •   Other skin and hair conditions
  •   Symptoms related to underlying disorders may include weight loss or gain, fatigue, and enlarged body parts. 

How is CVG Diagnosed?

Bulldog scalp syndrome is particularly easy and fast to diagnose. Dermatologists examine the scalp physically. The presence of furrows and ridges is sufficient to diagnose CVG.

In rare cases, a specialist will further assess other visible symptoms to classify them as primary or secondary CVG.

In the case of secondary CVG, diagnostic tests such as skin biopsy and blood tests may be ordered to check for underlying disorders such as thyroid, acromegaly, or other scalp inflammatory diseases.

Patients with CVG are advised to avoid self-treatment to ensure a correct diagnosis has been made by a certified dermatologist, who may, in turn, refer them to specialists based on the findings. 

What does Bulldog scalp syndrome look like? 

Two of our patients in the above images struggled with both Bulldog Scalp Syndrome/Cutis Verticis Gyrata (CVG) and Acne Keloidalis Nuchae (AKN). Notice the visible ridges and furrows on the scalp as well as the patchy hair loss.

 

How Do You Treat CVG?

It is important to determine the form of Bulldog scalp syndrome/CVG diagnosed (primary or secondary) before proceeding with the treatment to ensure the methods used are effective.

To properly treat CVG, specialists are required to manage the cosmetic needs associated with changes in the scalp skin and the underlying conditions leading to the effects on the skin.

Cosmetic Treatment

  1. Surgical procedures

The most effective treatment method is surgical intervention, which depends on the location and size of the CVG folds. Big folds may require skin grafts and local flap reconstructions, while smaller furrows can be managed with simple cuts out of the affected area.

Surgical procedures include:

  • Scalp reduction to flatten the surface.
  • Laser Therapy to make the scalp skin smooth.
  • Hair transplant
  1. Topical Treatments to manage dryness and itching.
  2. Use of corticosteroid injections to reduce inflammation.

Managing Underlying Conditions

  • Hormonal therapy
  • Treatment of associated dermatological conditions
  • Preventing progressive skin changes through essential treatment of underlying disorders.

Self-Care

  • Patients are encouraged to practice scalp hygiene by cleaning between furrows and ridges to prevent bad odors and secondary infections. Ensure products used are mild to the skin to reduce irritation.
  • Avoid tight headgear or hairstyles to minimize scalp trauma.

CVG patients, especially those with associated conditions, require regular monitoring by specialists to assess progress and address complications or adjust treatment.

Relationship Between CVG (Cutis Verticis Gyrata) and AKN (Acne Keloidalis Nuchae (AKN)

CVG and AKN are both scalp conditions prevalent in men and characterized by small and large folds on the back region of the head. A 2022 research study on the relationship between dermal thickening and excessive folding in both disorders revealed that the spreading of AKN lesions preceded the onset of CVG by two years for patients affected by the two disorders. 

In the wake of the research findings associating AKN and CVG, dermatologists have become more aware of the possibility of patients experiencing one after the other or both simultaneously. Specialists can now take precautions in addition to suggested treatment methods to manage the disorders. 

Frequently Cutis Verticis Gyrata Asked Questions (FAQ)

Is Cutis Verticis Gyrata treatable?

Treatment options include managing underlying conditions, symptoms, and cosmetic needs.

Is Cutis Verticis Gyrata hereditary?

Some forms of CVG contain genetic components. However, the disease is rare and patternless.

What causes Cutis Verticis Gyrata/Bulldog Scalp Syndrome? 

The exact cause is yet to be established. It can be either primary (spontaneous disease) or secondary (underlying conditions).

How can I treat Cutis Verticis Gyrata? 

Complete a free consultation for your hair loss with board-certified dermatologist Dr. Sanusi Umar by using this link: https://dru.com/hair-free-consultation/ or

Check out Dr. Bumpinator’s remarkable journeys with his patients using this link:  https://bumpinator.com/bumpinator/how-this-big-lucky-akn-bear-overcame-his-breaking-point-part-1/

 

References

Jeong, J., Daniela Tiemi Sano, Silvia Regina Martins, Antônio José Tebcherani, & Paula, A. (2014). Primary essential cutis verticis gyrata – Case report. Anais Brasileiros de Dermatologia, 89(2), 326–328. https://doi.org/10.1590/abd1806-4841.20142949

Koregol, S., Yatagiri, R., Warad, S., & Itagi, N. (2016). A rare association of scleromyxedema with cutis verticis gyrata. Indian Dermatology Online Journal, 7(3), 186. https://doi.org/10.4103/2229-5178.182365

Larsen, F., & Birchall, N. (2007). Cutis verticis gyrata: Three cases with different aetiologies that demonstrate the classification system. Australasian Journal of Dermatology, 48(2), 91–94. https://doi.org/10.1111/j.1440-0960.2007.00343.x