Perifolliculitis Capitis Abscedens et Suffodiens
- Author: Malgorzata D Skibinska, MD, PhD; Chief Editor: Dirk M Elston, MD more...
Background
Perifolliculitis capitis abscedens et suffodiens (PCAS) is a therapeutically challenging suppurative scalp disease of unknown etiology. Spitzer first described the disease in 1903, and Hoffman named it descriptively in 1907 (suffodiens is from the Latin suffodio, meaning to dig under).[1, 2] It predominantly occurs in black males in their second-to-fourth decade of life. The clinical course is chronic and unpredictable with relapses, although spontaneous resolution may occur.[3, 4]
Pathophysiology
Perifolliculitis capitis abscedens et suffodiens (dissecting cellulitis of the scalp) can be associated with acne conglobata, hidradenitis suppurativa, and pilonidal cysts, with follicular blockage as the proposed common mechanism. As retention of material dilates follicles and causes them to rupture, keratin and organisms from the damaged hair follicles can initiate a neutrophilic and granulomatous response (see the image below). Bacterial infection appears to be a secondary event, not an etiologic factor in the pathogenesis.[3, 5, 6]
A white patient with painful nodules. Image used with permission from Medical Science Monitor, 2000, 6(3): 602-4. Epidemiology
Frequency
International
No data are available, but the disease is uncommon.
Mortality/Morbidity
Perifolliculitis capitis abscedens et suffodiens (dissecting cellulitis of the scalp) is not life threatening, but it is chronic and relapsing and can be complicated by squamous cell carcinoma.
Race
Perifolliculitis capitis abscedens et suffodiens (dissecting cellulitis of the scalp) is found most commonly in black men, but white persons are also affected.
Sex
Perifolliculitis capitis abscedens et suffodiens (dissecting cellulitis of the scalp) is found mostly in men, although cases in women are also reported.
Age
The most common age group affected is those aged 18-40 years.
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