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3-year history of scalp lesions with discharge
Last reviewed: December 2022
Author: Dr Ian Coulson, Consultant Dermatologist and Editor-in-Chief, 2022.
Edited by the DermNet content department
Background
This 23-year-old man has a 3-year history of lesions on his scalp. These lesions can be painful and fluctuant swellings often discharge.
What is this condition?
This is dissecting cellulitis of the scalp, also known as perifolliculitis capitis abscedens et suffodiens and Hoffman disease. It produces nodules, cysts, and discharging scalp lesions with eventual patchy scarring hair loss (alopecia).
What other skin diseases may it be associated with?
It may be associated with severe acne (including acne conglobata) and hidradenitis suppurativa, collectively called the follicular occlusion triad. More recently, pilonidal sinus disease has been added to this list (follicular occlusion tetrad).
List 4 possible medical therapies
Therapy is difficult. It involves considering the following:
- Long-term antibiotics
- Oral zinc supplements
- Oral retinoids
- Intralesional steroids for acute inflammatory lesions
- TNF inhibitors.