Dissecting Cellulitis of the Scalp: Current Insights and Therapeutic Advances

Dissecting cellulitis of the scalp is a rare, primary neutrophilic cicatricial alopecia that manifests with painful nodules, abscesses, and interconnected sinus tracts. It predominantly affects young adult men and frequently coexists with other follicular occlusion disorders, including hidradenitis suppurativa and acne conglobata. Clinical evaluation and trichoscopy are key elements of the diagnostic work-up, allowing detection of both early non-scarring inflammatory changes and features of chronic fibrotic disease. Although a wide array of therapeutic options has been explored, which range from oral antibiotics and retinoids to biologic agents, evidence-based guidelines remain lacking, and disease recurrence is common upon treatment cessation. Recent therapeutic advances have identified tumor necrosis factor-α, interleukin-17, and interleukin-23 inhibitors as promising options in recalcitrant cases. Adjunctive modalities such as laser-based therapies, surgical excision, and photodynamic protocols further expand the therapeutic paradigm, particularly for advanced disease. Increasing clinical and pathogenic evidence supports shared inflammatory pathways between dissecting cellulitis of the scalp and hidradenitis suppurativa, suggesting that these entities may represent anatomical variants within the same disease spectrum, driven by follicular occlusion and dysregulated immune responses. This evolving view harbors important implications for disease classification and management. The aim of this review is to provide an updated overview of the latest evidence on dissecting cellulitis of the scalp, encompassing its epidemiology, pathogenesis, clinical presentation, diagnostic algorithm, and therapeutic strategies. Additionally, we critically evaluate the conceptual framework for viewing dissecting cellulitis of the scalp and hidradenitis suppurativa as phenotypic variants of a unified inflammatory disorder and assess the current unmet need and future perspectives in translational research and disease management.