Refractory Dissecting Cellulitis of the Scalp Treated With Risankizumab

Area of Science:

• Dermatology
• Immunology

Background:

• Perifolliculitis capitis abscedens et suffodiens, or dissecting cellulitis (DC), is a rare, chronic scalp disease.
• It typically affects middle-aged males of African descent, presenting with multinodular lesions, purulent drainage, and sinus tracts.

Observation:

• The exact etiology of DC remains unknown, but theories suggest follicular occlusion leading to bacterial infection, destruction, and subsequent inflammatory responses.
• DC shares potential etiological links with conditions like acne conglobata, pilonidal cysts, and hidradenitis suppurativa, all associated with follicular occlusion.

Findings:

• Treatment approaches for DC are varied due to a lack of established consensus.
• This case report details the successful use of risankizumab, an interleukin-23 (IL-23) inhibitor, in managing DC.

Implications:

• The findings suggest that IL-23 inhibition may represent a novel therapeutic avenue for dissecting cellulitis.
• Further research into targeted immunotherapies like IL-23 inhibitors could offer new treatment strategies for this debilitating condition.