Case Report: Bimekizumab for dissecting cellulitis of the scalp

Dissecting cellulitis of the scalp (DCS) is a cicatricial alopecia characterized by follicular occlusion that progresses to abscess formation and rupture, driven by an intense inflammatory cascade. Part of the follicular occlusion tetrad, DCS typically presents with painful nodules and interconnecting sinus tracts localized to the scalp. Treatment of this recalcitrant disease is difficult, and there is a need for efficacious and durable therapies that control inflammation and address the underlying pathophysiology of disease. Here is the first reported use of bimekizumab, a dual inhibitor of interleukin (IL)-17A and IL-17F, as monotherapy for the management of DCS. The patient was a male aged 27 years who presented with difficult-to-treat DCS and hair loss. After failing to achieve symptomatic control with standard treatments such as oral antibiotics, aggressive topical therapy, and intralesional steroids, the patient received bimekizumab (320 mg subcutaneously every 2 weeks through week 16, and 320 mg every 4 weeks thereafter). At the 16-week follow-up, the patient reported no symptoms of DCS or adverse events from treatment. The outcomes from our case report provide evidence supporting the inhibition of IL-17A and IL-17F for the treatment of DCS to address the underlying inflammatory mechanism, reduce symptoms, and help patients achieve control over their disease and improve their overall quality of life.