Severe dissecting scalp cellulitis successfully treated with serial excisions in combination with anti-TNF therapy

The management of dissecting scalp cellulitis involves medical treatment with oral antibiotics and isotretinoin, as well as surgical input in more severe cases. In extensive disease, a full scalpectomy with reconstruction can be required. We report a case of severe dissecting scalp cellulitis in a 34-year-old man who underwent serial scalp excisions over three years, with wounds being left to heal by secondary intention. Initially, the excisions helped to control symptoms but, once the patient was on concurrent anti-TNF therapy, further excisions were successful in reducing disease load and inducing remission. He remained disease free at the 20 months follow-up. This case is the first of its kind to be described in the literature and it highlights how a conservative, staged surgical approach, in combination with anti-TNF therapy, can be effective in the management of severe dissecting scalp cellulitis. In doing so, it offers an alternative to full scalpectomy with reconstruction.