Perifolliculitis Capitis Abscedens et Suffodiens Clinical Presentation

  • Author: Malgorzata D Skibinska, MD, PhD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Aug 17, 2011
 

History

  • Perifolliculitis capitis abscedens et suffodiens (dissecting cellulitis of the scalp) begins as a simple folliculitis, most often of the vertex and/or occiput, with clusters of perifollicular pustules rapidly followed by abscess and sinus formation.
  • Nodules range from a few millimeters to several centimeters in diameter and may be firm or fluctuant.
  • Seropurulent fluid may be expressed from fluctuant nodules.
  • Lesions at different stages may persist for years, healing with a scarring alopecia.
  • Perifolliculitis capitis abscedens et suffodiens (dissecting cellulitis of the scalp) has a strong tendency for recurrence.
  • No systemic symptoms are usually evident.
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Physical

  • Vertex and occipital regions of the scalp are sites most often affected by perifolliculitis capitis abscedens et suffodiens (dissecting cellulitis of the scalp).
  • The main physical signs, depending on the disease stage, are perifollicular pustules, tender nodules (some discharging pus or a jellylike substance), intercommunicating sinuses between nodules, and patchy alopecia with scarring.[7, 8] See the images below. Dissecting cellulitis in a black man. Painful cutaDissecting cellulitis in a black man. Painful cutaneous nodules and patchy alopecia. Side view of a black man with painful cutaneous noSide view of a black man with painful cutaneous nodules and patchy alopecia, characteristic of dissecting cellulitis. A white patient with painful nodules. Image used wA white patient with painful nodules. Image used with permission from Medical Science Monitor, 2000, 6(3): 602-4. A white patient with painful nodules after 3 monthA white patient with painful nodules after 3 months of isotretinoin treatment. Image used with permission from Medical Science Monitor, 2000, 6(3): 602-4.
  • Shedding hair from the surface of nodules and sparing in between the inflamed areas can be observed.
  • Regional lymphadenopathy is rarely noted.
  • Spondyloarthropathy has been reported in patients with perifolliculitis capitis abscedens et suffodiens (dissecting cellulitis of the scalp).[9, 10]
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Causes

The cause of perifolliculitis capitis abscedens et suffodiens (dissecting cellulitis of the scalp) is not known.

  • The hypothesis is that blockage of follicles, retention of contents, and subsequent rupture leads to inflammation. Acne conglobata, hidradenitis suppurativa, and pilonidal cysts are frequent concomitant diseases, often referred to as the follicular occlusion triad or tetrad.
  • Bacterial infection is probably secondary in the course of the disease because most bacteriological cultures are negative. The most frequently isolated pathogens are Staphylococcus aureus, Staphylococcus epidermidis, and Staphylococcus albus.
  • Keratosis-ichthyosis-deafness syndrome has been reported in association with the follicular occlusion triad in 2 patients.[11, 12]
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Contributor Information and Disclosures
Author

Malgorzata D Skibinska, MD, PhD  Locum Consultant Dermatologist, Department of Dermatology, Basildon University Hospital, UK

Malgorzata D Skibinska, MD, PhD is a member of the following medical societies: British Association of Dermatologists, British Medical Association, British Society of Allergy and Clinical Immunology, Royal College of Physicians of the United Kingdom, and Royal Society of Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Leonard Sperling, MD  Chair, Professor, Department of Dermatology, Uniformed Services University of the Health Sciences

Leonard Sperling, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey J Miller, MD  Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Professors of Dermatology, North American Hair Research Society, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Glen H Crawford, MD  Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital

Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

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  2. Spitzer L. Dermatitis follicularis et perifollicularis conglobata. Dermatol Zeitschrift (Berlin). 1903;10:109-20.

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  32. Dubost-Brama A, Delaporte E, Alfandari S, Piette F, Bergoend H. [Perifolliculitis capitis abscedens and suffidiens. Efficacy of isotretinoin]. Ann Dermatol Venereol. 1994;121(4):328-30. [Medline].

  33. Koca R, Altinyazar HC, Ozen OI, Tekin NS. Dissecting cellulitis in a white male: response to isotretinoin. Int J Dermatol. Aug 2002;41(8):509-13. [Medline].

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  37. Sivakumaran S, Meyer P, Burrows NP. Dissecting folliculitis of the scalp with marginal keratitis. Clin Exp Dermatol. Sep 2001;26(6):490-2. [Medline].

 
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Dissecting cellulitis in a black man. Painful cutaneous nodules and patchy alopecia.
Side view of a black man with painful cutaneous nodules and patchy alopecia, characteristic of dissecting cellulitis.
A white patient with painful nodules. Image used with permission from Medical Science Monitor, 2000, 6(3): 602-4.
A white patient with painful nodules after 3 months of isotretinoin treatment. Image used with permission from Medical Science Monitor, 2000, 6(3): 602-4.
Histopathologic picture of biopsy taken from a white patient with perifolliculitis capitis abscedens et suffodiens. Hematoxylin and eosin stain, original magnification 400X. Image used with permission from Medical Science Monitor, 2000, 6(3): 602-4.
 
 
 
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