Dissecting Cellulitis of the Scalp: Causes, Symptoms, and Treatment
Medically reviewed by Achuta Uppu, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Dissecting Cellulitis of the Scalp?
A dermatologist, a doctor who treats skin, hair, and scalp problems, usually leads care for dissecting cellulitis of the scalp. Severe cases may need a reconstructive surgeon, a doctor who repairs the skin with surgery. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is dissecting cellulitis of the scalp?
Dissecting cellulitis of the scalp is a rare condition that causes tender lumps on the scalp. Over time, the lumps form draining sinuses, which are tunnels under the skin that leak fluid. This often leaves scars and hair loss. It is also called perifolliculitis capitis abscedens et suffodiens or Hoffman's disease.
It is one of a group of conditions linked to blocked hair follicles, the tiny pockets that hold each hair. The others in the group are hidradenitis suppurativa, acne conglobata, and pilonidal disease.
Symptoms
Signs of dissecting cellulitis of the scalp include:
- Tender lumps on the scalp that come back again and again.
- Small bumps with pus and fluid-filled lumps, most often on the top and back of the head, in the early stage.
- Painful lumps joined by tunnels under the skin if the condition is not treated.
- Scarring that leads to hair loss that may be permanent.
- Distress about how the scalp looks, and possible odor if the scalp gets infected.
Causes and who gets it
Doctors do not fully understand what causes dissecting cellulitis of the scalp. Blocked hair follicles seem to be a key feature. When pores are blocked, bacteria can infect them and tunnels can form. Even so, no specific germ has been tied to the condition.
It mainly affects young adult men, most often African American men. It has also been seen in white people and in women.
How doctors diagnose it
Diagnosis relies mainly on a clinical exam and a trichoscopy exam, which is a close-up look at the scalp and hair. A skin sample, called a biopsy, can help in hard cases. Early on, the close-up scalp exam may look like alopecia areata, another cause of patchy hair loss. Skin cancer is rare in this condition but has been described, and doctors check for it.
Treatment
Treatment depends mostly on how severe the condition is. Advice comes from small studies and case reports because there are few large trials.
In mild cases, first treatments include better scalp hygiene, antiseptics, antibiotics put on the skin, draining a lump with a needle, antibiotics taken by mouth, and steroid shots. In more severe cases, oral antibiotics combined with rifampin, with or without steroids, have been shown to be effective. Isotretinoin has resulted in remission for some people, which means the disease calmed down. In one study of 66 patients, most were treated with oral isotretinoin or adalimumab, and the response was partial and mild. Laser hair removal may help before inflammation starts.
For cases that do not improve, surgery to remove the diseased scalp and cover it with a skin graft is often needed and successful. A skin graft is skin taken from another part of the body. Surgery and skin grafting can offer a long-lasting cure, but many people see a surgeon late.
When to see a doctor
See a doctor if you have tender, draining lumps on your scalp or hair loss with scarring. Early treatment in the first stage can lead to hair regrowth. Lumps that keep coming back need a doctor's care, because repeat flare-ups raise the risk of bone infection.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. Either can look at the scalp, refer you to a dermatologist, and help coordinate care over time, including a surgeon if needed.
Common questions
Does dissecting cellulitis of the scalp cause permanent hair loss?
It can, if the condition is not treated. Scarring from the lumps can cause permanent hair loss. Early treatment in the first stage can lead to hair regrowth.
Who is most likely to get dissecting cellulitis of the scalp?
Young adult men are most likely to get it, especially African American men. It has also been described in white people and in women.
Can dissecting cellulitis of the scalp be cured?
Yes, in some cases, with surgery. Surgery and skin grafting can offer a durable cure. The lumps tend to relapse, which means they come back. Several case studies report long-term remission and possible cure with complete scalp removal and skin grafting.
What other conditions are linked to dissecting cellulitis of the scalp?
Several conditions can occur along with it. These include hidradenitis suppurativa, acne conglobata, and pilonidal disease. Joint problems such as arthritis have also been linked to it.
Sources
- National Library of Medicine (PubMed Central) - Dissecting Cellulitis of the Scalp: Case Discussion, Unique Considerations, and Treatment Options
- National Library of Medicine (PubMed Central) - Dissecting cellulitis of the scalp: clinical characteristics and impact on quality of life of 66 Brazilian patients
- National Library of Medicine (PubMed Central) - Dissecting Cellulitis of the Scalp: A Review and Case Studies of Surgical Reconstruction
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
