Dissecting Cellulitis of the Scalp
Dissecting cellulitis of the scalp (Dissecting Cellulitis of the Scalp), also known as Hoffman disease, is a rare, chronic inflammatory skin disease that affects the hair follicles of the scalp. The disease presents as the formation of painful, pus-filled lesions, which later create tunnels beneath the skin and lead to scarring and permanent bald patches.
Dissecting Cellulitis of the Scalp
Dissecting cellulitis of the scalp (Dissecting Cellulitis of the Scalp), also known as Hoffman disease, is a rare, chronic inflammatory skin disease that affects the hair follicles of the scalp. The disease presents as the formation of painful, pus-filled lesions, which later create tunnels beneath the skin and lead to scarring and permanent bald patches.
Dissecting Cellulitis of the Scalp
Dissecting cellulitis of the scalp (Dissecting Cellulitis of the Scalp), also known as Hoffman disease, is a rare, chronic inflammatory skin disease that affects the hair follicles of the scalp. The disease presents as the formation of painful, pus-filled lesions, which later create tunnels beneath the skin and lead to scarring and permanent bald patches.
The disease usually begins at the crown and gradually spreads backwards and to the sides of the scalp.
Causes and risk factors
- The exact cause is unknown, but it is known that the disease is caused by blockage and rupture of the hair follicles, creating acute inflammation and sometimes a secondary infection.
- Curly, dense hair type (more common in men of Afro-Caribbean descent)
- An association with other conditions known as the "follicular occlusion tetrad": hidradenitis suppurativa, acne conglobata and pilonidal cysts
Symptoms and signs
- Painful, swollen pustules on the scalp that fill with pus
- Large, edematous lesions
- Formation of discharging subcutaneous tunnels
- Scarring bald patches, usually permanent
- In certain cases: itching, pain, an unpleasant odor and secondary infections
Diagnosis
The diagnosis is made mainly by a dermatologist based on the clinical appearance
A culture of fluid or pus to assess infection
A scalp biopsy in case of doubt, in order to rule out other skin diseases
Treatment options
Treatment includes topical, systemic and procedural therapies according to the severity of the case.
- Topical treatments:
- Antiseptic shampoos and preparations
- Topical antibiotics
- Topical steroids to reduce inflammation
- Systemic treatments:
- Oral antibiotics
- Retinoids – effective in reducing inflammation and follicular occlusion
- Short-course systemic steroids during an acute flare
- Biologic treatments in severe or treatment-resistant cases
- Procedural treatments:
- Local steroid injections
- Drainage or excision of large abscesses and cysts
- Laser or photodynamic treatments to reduce inflammation around the follicles
- Skin grafting in extensive cases
Prognosis
The disease is chronic, sometimes lasting many years, and tends at times to run in waves of flare-up and improvement. Although it is possible to achieve control of the symptoms and reduce future damage, the scars and bald patches that have formed are usually irreversible. Early diagnosis and appropriate intervention reduce the risk of permanent damage.
In summary
Dissecting cellulitis of the scalp is a severe, rare inflammatory disease that causes scarring bald patches and persistent pain. Combined treatment and close follow-up with a dermatologist can significantly improve quality of life, reduce flare-ups and prevent irreversible damage to the hair.
Frequently asked questions
The disease is chronic, sometimes lasting many years, and tends at times to run in waves of flare-up and improvement. Although it is possible to achieve control of the symptoms and reduce future damage, the scars and bald patches that have formed are usually irreversible. Early diagnosis and appropriate intervention reduce the risk of permanent damage.
You can book a personal consultation with Dr. Rimma Laufer Britva in Kfar Saba via the website form or a WhatsApp message. The consultation includes an accurate diagnosis and a personal treatment plan.
