DermNet provides Google Translate, a free machine translation service. Note that this may not provide an exact translation in all languages

Perifolliculitis capitis abscedens et suffodiens

Author: Dr Leah Jones, Medical Registrar, Christchurch, New Zealand. DermNet NZ Editor in Chief: Adjunct A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. Copy edited by Gus Mitchell. July 2020.


What is perifolliculitis capitis abscedens et suffodiens?

Perifolliculitis capitis abscedens et suffodiens is an uncommon cause of scarring alopecia characterised by perifollicular and follicular pustules and nodules [1].

It is also known as dissecting cellulitis of the scalp and Hoffman disease.

Perifolliculitis capitis

Who gets perifolliculitis capitis abscedens et suffodiens?

Perifolliculitis capitis abscedens et suffodiens is most prevalent in men of African descent in the third, fourth and fifth decades of life, but it may also affect African women, Caucasian individuals and other ethnicities, and occasionally, children [1,2].

Perifolliculitis capitis abscedens et suffodiens sometimes occurs in people who have other forms of follicular occlusion syndrome.

What causes perifolliculitis capitis abscedens et suffodiens?

A defect in follicular keratinisation causes occlusion and subsequent inflammatory destruction of the follicle [2,3]. An aberrant immune to response to commensal bacteria may be involved with the pathogenesis, particularly coagulase-negative staphylococci [1].

What are the clinical features of perifolliculitis capitis abscedens et suffodiens?

Perifolliculitis capitis abscedens et suffodiens can affect single or multiple areas of the scalp, with a predilection for the vertex and posterior scalp [3]. It is often painful.

Signs can include [1]:

  • Perifollicular and follicular pustules
  • Nodules and pseudocysts, often with purulent exudate
  • Interconnecting sinuses
  • Abscess
  • Hair loss
  • Keloid scars (uncommon).

The clinical severity of perifolliculitis capitis abscedens et suffodiens depends on the size and number of the lesions, and the extent of the scarring and exudate [3].

Patients with perifolliculitis capitis abscedens et suffodiens may also have hidradenitis suppurativa, nodulocystic acne and pilonidal diseaese [1].

Perifolliculitis capitis abscedens et suffodiens is also associated with arthritis and spondyloarthropathy [4], keratitis-ichthyosis-deafness syndrome [5], and sternocostoclavicular hyperostosis [1].

Perifolliculitis capitis

What are the complications of perifolliculitis capitis abscedens et suffodiens?

Perifolliculitis capitis abscedens et suffodiens can lead to secondary bacterial infection due to Staphylococcus aureus, Pseudomonas, and anaerobic bacteria [2,3,5,6].

Hair loss is temporary initially, but the deep inflammation eventually leads to patchy cicatricial alopecia, which can be very extensive [3].

Cutaneous squamous cell carcinoma has been reported to arise in a chronically inflamed lesion [7].

How is perifolliculitis capitis abscedens et suffodiens diagnosed?

Perifolliculitis capitis abscedens et suffodiens is a clinical diagnosis, based on the presence of typical draining pseudocysts on the scalp [3].

A swab of the exudate for culture is recommended to identify secondary bacterial infection [2,3]. The swab is often sterile.

A skin biopsy may show perifollicular mixed inflammatory infiltrate, abscess, and granuloma formation. Fibrosis is common [1].

What is the differential diagnosis for perifolliculitis capitis abscedens et suffodiens?

Perifolliculitis capitis abscedens et suffodiens can be confused with other inflammatory conditions of the scalp including:

What is the treatment for perifolliculitis capitis abscedens et suffodiens?

Perifolliculitis capitis abscedens et suffodiens is often chronic and difficult to treat [1,3].

Medical treatment

Drugs used to treat perifolliculitis capitis abscedens et suffodiens include:

Surgical treatment

Interventional procedures for perifolliculitis capitis abscedens et suffodiens include:

What is the outcome for perifolliculitis capitis abscedens et suffodiens?

Perifolliculitis capitis abscedens et suffodiens usually follows a chronic course with variable relapses [2,3]. The subsequent scarring alopecia results in permanent, patchy hair loss [1].

See smartphone apps to check your skin.
[Sponsored content]

 

Related information

 

References

  1. Scheinfeld N. Dissecting cellulitis (Perifolliculitis Capitis Abscedens et Suffodiens): a comprehensive review focusing on new treatments and findings of the last decade with commentary comparing the therapies and causes of dissecting cellulitis to hidradenitis suppurativa. Dermatol Online J 2014; 20: 22692. PubMed
  2. Brook I. Recovery of anaerobic bacteria from a case of dissecting cellulitis. Int J Dermatol 2006; 45: 168. DOI: 10.1111/j.1365-4632.2005.02594.x. PubMed
  3. Alexis A. Dissecting cellulitis of the scalp (DCS). Uptodate. 2019 [cited 2020 Mar 6]. Available at: https://www.uptodate.com/contents/dissecting-cellulitis-of-the-scalp?search=perifolliculitis%20capitis%20abscedens&source=search_result&selectedTitle=1~14&usage_type=default&display_rank=1
  4. Thein M, Hogarth MB, Acland K. Seronegative arthritis associated with the follicular occlusion triad. Clin Exp Dermatol 2004; 29: 550. DOI: 10.1111/j.1365-2230.2004.01582.x. PubMed
  5. Maintz L, Betz RC, Allam JP, et al. Keratitis-ichthyosis-deafness syndrome in association with follicular occlusion triad. Eur J Dermatol 2005; 15: 347. PubMed
  6. Ramesh V. Dissecting cellulitis of the scalp in 2 girls. Dermatologica 1990; 180: 48. DOI: 10.1159/000247985. PubMed
  7. Curry SS, Gaither DH, King LE Jr. Squamous cell carcinoma arising in dissecting perifolliculitis of the scalp. A case report and review of secondary squamous cell carcinomas. J Am Acad Dermatol 1981; 4: 673. DOI: 10.1016/s0190-9622(81)70068-9. PubMed

On DermNet NZ

Other websites

Books about skin diseases