Dissecting Cellulitis of the Scalp - Symptoms, Causes & Treatment
Medically reviewed by Dr. Anand S. Urhekar, MD, MD Pathology, Clinical Advisor · Last updated July 2026
A chronic inflammatory scalp condition, part of the follicular occlusion tetrad alongside hidradenitis suppurativa and acne conglobata. It produces boggy nodules, interconnecting sinus tracts that discharge pus, and progressive scarring hair loss, most often in young men of African descent.
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Quick Answer
Dissecting cellulitis of the scalp is a chronic follicular occlusion disorder causing painful boggy nodules, pus-draining interconnected sinus tracts and permanent scarring hair loss, most often in young men of African descent. Treatment is difficult: oral isotretinoin is the most effective medical option, with tetracyclines, intralesional steroids, adalimumab and laser hair removal used alongside.
Symptoms
- Boggy, fluctuant nodules on the vertex and occiput
- Interconnecting sinus tracts discharging pus
- Pain and tenderness
- Progressive scarring hair loss
- Often coexists with hidradenitis suppurativa or severe acne
Causes & Risk Factors
- Follicular occlusion and rupture with secondary inflammation
- Genetic predisposition; most common in men of African descent aged 20–40
- Secondary bacterial colonisation
- Not primarily an infection, despite the appearance
Treatment & Management
- Oral isotretinoin — the most effective single therapy
- Oral tetracyclines or rifampicin plus clindamycin
- Intralesional corticosteroid injections
- Adalimumab or other biologics in refractory disease
- Laser hair removal, incision and drainage, or surgical excision for severe cases
When to See a Doctor
See a dermatologist early. Every month of untreated inflammation adds permanent hair loss, and antibiotics alone rarely control the condition.
Frequently Asked Questions
Is this an infection?
Not primarily. Bacteria colonise the tracts secondarily, which is why antibiotics help partially, but the underlying problem is follicular occlusion and inflammation — requiring anti-inflammatory or retinoid therapy.
Can the hair grow back?
Hair in scarred areas is permanently lost. Early control preserves the follicles that remain, which is why prompt specialist treatment matters.
Related Conditions
Medical References
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Medical Disclaimer: This information is for educational purposes only and is not intended as medical advice. The content on this page should not be used to diagnose or treat any health problem. Always consult with a qualified healthcare professional for proper medical evaluation, diagnosis, and treatment of your condition.