Surgical Excision and Skin Grafting for Severe Chronic Scalp Pyoderma: A Case Report and Literature Review

Chronic suppurative diseases of the scalp, including acne keloidalis nuchae (AKN), dissecting cellulitis of the scalp (DCS), and folliculitis decalvans, are characterized by the presence of persistent abscesses, fistulas, and progressive scarring. The treatment of these conditions often presents a challenge, requiring both pharmacological and surgical interventions. We present herein two cases of long-standing, chronic, refractory suppurative scalp conditions that were successfully treated with surgical excision and subsequent skin grafting. The first case is that of a 53-year-old man with AKN, characterized by extensive abscesses and scarring in the occipital region. The second case is that of a 61-year-old man with DCS, exhibiting recurrent folliculitis and abscesses. Both patients underwent a complete excision of the affected areas followed by full- or split-thickness skin grafts, resulting in favorable cosmetic outcomes. Histopathological examination in each case confirmed the diagnoses of AKN and DCS. These case reports underscore the effectiveness of surgical intervention in managing resistant cases of severe chronic suppurative diseases of the scalp, with good postoperative outcomes. This finding highlights the potential for improved quality of life with timely surgical management among patients suffering from these diseases.