When it comes to scalp health, most people think about dandruff, hair loss, or itching. But there’s a rare and often misunderstood condition that can have a major impact on both appearance and quality of life: dissecting cellulitis of the scalp (DCS).
This chronic inflammatory disorder doesn’t just affect the skin—it can also cause permanent hair loss, scarring, and emotional distress. In this article, we’ll break down what DCS is, why it happens, and the treatment options available today.
What Is Dissecting Cellulitis of the Scalp?
Dissecting cellulitis of the scalp (sometimes called perifolliculitis capitis abscedens et suffodiens) is a chronic inflammatory disease of the hair follicles.
It usually starts with small, painful lumps under the skin. Over time, these lumps may enlarge, form abscesses (collections of pus), and create tunnels (sinus tracts) under the scalp. The inflammation often leads to scarring and permanent hair loss in the affected areas.
DCS is rare but tends to affect young to middle-aged men, especially those of African descent. However, it can occur in women and in other ethnic groups as well.
What Causes It?
The exact cause of dissecting cellulitis remains unclear, but doctors believe several factors are involved:
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Follicular occlusion: Hair follicles become blocked, leading to inflammation and rupture.
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Immune response: The body reacts strongly to follicle damage, causing chronic inflammation.
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Bacterial role: While not always present, bacteria may worsen the inflammation.
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Genetics and hormones: These may play a role in who develops the condition.
Interestingly, DCS is considered part of the “follicular occlusion triad”, which also includes hidradenitis suppurativa (boils in skin folds) and acne conglobata (severe nodular acne).
Common Symptoms
People with dissecting cellulitis often notice:
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Painful lumps or nodules on the scalp
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Pus-filled bumps that may ooze or crust over
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Tunnels under the skin that connect inflamed areas
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Scarring and patchy hair loss
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Itching, tenderness, or burning sensation
Symptoms usually come and go in flare-ups, which can last weeks or months. Without treatment, the condition may progress and cause widespread scarring.
Diagnosis
Because DCS can look like other scalp conditions (such as fungal infections, folliculitis decalvans, or lupus), diagnosis can be tricky. A dermatologist may perform:
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Physical examination of the scalp
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Dermatoscopy (scalp magnification)
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Biopsy to confirm inflammation pattern
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Culture tests if bacterial infection is suspected
Early diagnosis is important to prevent irreversible scarring.
Treatment Options
There is no single cure for dissecting cellulitis, but several treatments can control inflammation and reduce flare-ups:
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Antibiotics – long-term courses may help reduce infection and inflammation.
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Oral retinoids (such as isotretinoin) – effective in many cases to reduce follicle blockage.
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Corticosteroids – injections or pills may calm severe flare-ups.
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Biologic therapies – newer options (like adalimumab) target the immune system for stubborn cases.
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Laser or surgery – in advanced cases, surgical removal of scarred tissue or laser therapy may be considered.
Alongside medical treatment, patients are often advised to:
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Keep the scalp clean and avoid irritating hair products.
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Manage stress, as it may worsen flare-ups.
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Work closely with a dermatologist for long-term care.
Living With DCS
Beyond the physical symptoms, dissecting cellulitis can affect mental health and self-confidence. Hair loss and scalp scarring often lead to embarrassment or social anxiety. Support groups, counseling, and online communities can provide encouragement and practical tips.
Final Thoughts
Dissecting cellulitis of the scalp is a rare but serious condition that requires medical attention. While it can’t always be cured, early diagnosis and tailored treatment can control symptoms, prevent scarring, and improve quality of life.
If you or someone you know is experiencing unexplained scalp lumps, drainage, or hair loss, don’t wait—see a dermatologist. The sooner it’s treated, the better the long-term outcome.
Disclaimer: This guide is for informational purposes only and does not replace professional medical advice. Always consult your healthcare provider before beginning any herbal remedy.