Perifolliculitis Capitis Abscedens et Suffodiens 

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

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]

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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 wA white patient with painful nodules. Image used with permission from Medical Science Monitor, 2000, 6(3): 602-4.
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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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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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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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