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Therapeutic Approach

Dissecting cellulitis of the scalp (DCS), also known as perifolliculitis capitis abscendens et suffodiens or Hoffman disease, is a condition that causes pustules and nodules on the scalp that may lead to scarring and hair loss.1 DCS is more likely to affect Black men.2 This condition is part of the follicular occlusion tetrad, which also includes hidradenitis suppurativa, acne conglobata, and pilonidal sinus. Treatment for dissecting cellulitis can be challenging as there is no drug approved by the U.S. Food and Drug Administration for specific treatment of this condition. In the senior author’s experience, first-line treatment options for mild DCS symptoms include benzoyl peroxide, topical clindamycin and oral doxycycline. In the cases of moderate to severe DCS, treatment with a combination of systemic rifampicin and clindamycin can be initiated. For refractory cases, isotretinoin and TNF inhibitors may also be considered. See Table 83-1.

Table 83-1Dissecting Cellulitis Treatment Table

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