Dissecting Cellulitis Presenting After Hair Restoration Surgery

Dissecting cellulitis (DC) of the scalp is a chronic inflammatory condition marked by neutrophilic cicatricial alopecia, often linked to staphylococcal antigens. This case report details a 34-year-old male with scarring acne who developed DC following follicular unit extraction (FUE) approximately four months prior. Trichoscopic examination revealed brown pigmented dots, erythema, and melicerous crusts. Abscess drainage yielded negative bacterial cultures, leading to a diagnosis of DC. The patient was treated with isotretinoin (20 mg/day), dutasteride (0.5 mg/day), intralesional steroid injections, and salicylic acid-based shampoo. After four months, the patient exhibited significant improvement, with trichoscopic findings showing regrowing hairs and no abnormal hair loss. DC, though commonly associated with other follicular occlusion disorders, has not been previously reported following FUE, indicating a need for awareness of this potential complication. The efficacy of isotretinoin and the emerging role of dutasteride in managing DC highlight the importance of early diagnosis and personalized treatment. Trichoscopy is crucial for diagnosis and monitoring, emphasizing the need for prompt intervention to prevent scarring alopecia. Caution is advised when considering FUE in patients with severe inflammatory acne due to the risk of developing DC.