Dissecting Cellulitis of the Scalp: Linking Pathogenesis to Therapy.

Area of Science:

• Dermatology
• Immunology
• Inflammatory Disorders

Background:

• Dissecting cellulitis of the scalp (DCS) is a chronic follicular occlusion disorder causing scarring alopecia.
• Traditional treatments like retinoids, antibiotics, and surgery offer variable efficacy and challenging long-term remission.
• Emerging research highlights immunological links with hidradenitis suppurativa (HS) and autoinflammatory conditions.

Purpose of the Study:

• To review current evidence on medical, procedural, and emerging targeted therapies for DCS.
• To emphasize the evolving role of biologics and small-molecule inhibitors in managing DCS.
• To provide guidance on a phenotype-driven, stepwise treatment approach.

Main Methods:

• Systematic review of literature up to 2025, including case reports, series, cohorts, and systematic reviews.
• Analysis of data on conventional therapies, biologics (anti-TNF-α, IL-17, IL-23), and Janus kinase (JAK) inhibitors.
• Focus on evidence for refractory, syndromic, or severe DCS presentations.

Main Results:

• Systemic retinoids remain the first-line systemic therapy for DCS.
• Biologics targeting TNF-α, IL-17, and IL-23 pathways, along with JAK inhibitors, show growing promise for difficult-to-treat cases.
• These targeted therapies are increasingly supported by evidence for moderate-to-severe, treatment-resistant, or syndromic DCS.

Conclusions:

• A stepwise, phenotype-driven approach is recommended for DCS management.
• Systemic retinoids are foundational, while biologics offer a rational, evidence-supported option for advanced disease.
• Further controlled studies are necessary to optimize treatment sequencing, duration, and combination strategies.