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What is Dissecting Cellulitis?

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Published on June 10, 2024. Last Updated on June 10, 2024.

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 but symptoms can be managed to reduce pain and provide some level of comfort.

It is classified as 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 to figure out the main cause of DC, nevertheless, they are working to 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 over time becomes infected with bacteria, which leads 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. Avoid using them 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. Such include gels, lotions, ointments, and creams. This 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. This procedure is, however, for specific patients with severe cases. Surgical procedures may be followed by other treatment methods for better results if requested by the patient. 

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. Administered directly onto affected areas. It is a painful procedure but with fewer side effects compared to 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. 

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 at the back of the head. Although common in males of the African-American ethnicity, AKN can also affect people from other races.

AKN is often mistaken or misdiagnosed as razor bumps or as keloidal conditions and is far worse if left untreated. Ensure you get a diagnosis from a board-certified dermatologist like Dr. Sanusi Umar by using this link: 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. 

Multifaceted treatment is applied in such instances to ensure both conditions 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 by using this link: https://dru.com/hair-free-consultation/ or using 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