Back issues No.3 - 2002 / Case Report  

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Dissecting Cellulitis of the Scalp—Clinicopathologic Analysis of Eight Cases and Literature Review—
Fu-Fang Hsieh Mark Ming-Long Hsu J.Yu-Yun Lee
Dermatol Sinica 20: 200-206, 2002

Dissecting cellulitis of the scalp is an uncommon, chronic, progressive suppurative disease that predominantly affects black men and only rarely seen in Orientals or Whites. We reported the clinicopathologic findings of 8 cases diagnosed in the National Cheng-Kung University Hospital (NCKUH) from 1988 to 2001, the largest series to date. The patients were all young men between 17 and 26 years of old, mean 20.6 years. All presented with painful, fluctuant nodules and abscesses with hair loss mainly on the vertex of scalp, for durations ranging from 1/2 month to 5 years (mean 1.6 years). Skin biopsies in 4 patients revealed from ruptured follicular cyst-like findings (mild destruction of hair follicules and epidermal hyperplasia) in small early lesions to extensive suppurative and granulomatous inflammation in the lower dermis and subcutis with fibrosis in large or more advanced lesions. Cultures of drained pus were negative. These patients were treated with oral isotretinoin therapy (dose: 0.5-1.0mg/kg/day) for 2 to 28 weeks (mean 13.8 weeks). Of 3 patients treated longer than 16 weeks, only one recurred with total dose less than 120 mg/kg. Four patients receiving short-term therapy ( <16 weeks ) developed recurrence in about 6 months. Based on the pathogenesis, the histopathologic findings, and the beneficial effect of isotretinoin, nosology of this disease was discussed.

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