Acne Vulgaris – Dissecting Cellulitis

Dissecting Cellulitis (also called Perifolliculitis Capitis Abscedens Et Suffodiens) is a variant of acne that is very similar to hidradenitis suppurativa but on the scalp and is a rare skin disease that I encounter in both my the Woodlands dermatology and Conroe dermatology offices.  It most commonly occurs in adult men and is predominantly located on the vertex and occipital areas of the scalp.  Although “cellulitis” is in the name, it is not an infectious process but an inflammatory disease of the pilosebaceous/hair follicle unit.  Initially, occlusion of the hair follicle occurs creating a rupture of sebum (oil), keratinaceous debris, and hair into the surrounding dermis.  The immune system forms an abscess in response to this “foreign” material and draining sinuses ultimately result which can perforate the surface of the skin.  Long term antibiotics such as doxycycline are usually used for their anti-inflammatory properties and to decrease the bacterial colonization that is very common in dissecting cellulitis. I recommend that my patients follow up monthly for intralesional kenalog injections into the draining sinuses, which can convert them into a more quiescent state.