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Acta Dermatovenerol Croat 2018 Oct;26(3):255-289

Ines Sjerobabski Masnec, MD, Department of Dermatology and Venereology, Sestre milosrdnice University Hospital Center , Vinogradska 29, 10000 Zagreb , Croatia;

The case of a 26-year-old male patient with perifolliculitis capitis abscedens et suffodiens (PCAS) who later developed hidradenitis suppurativa (HS) and exacerbation of acne is presented. The patient did not respond well to conventional treatment including isotretinoin and oral antibiotics. Quality of life was significantly impaired. Read More

J Dtsch Dermatol Ges 2018 Oct;16(10):1219-1227

Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

An Bras Dermatol 2017 Sep-Oct;92(5):724-726

Alopecia Outpatient Clinic at Hospital Naval Marcílio Dias (HNMD) - Rio de Janeiro (RJ), Brazil.

Yellow dots are follicular ostium filled with keratin and/or sebum. Initially, they were exclusively associated with alopecia areata. Currently they have also been described in androgenetic alopecia, chronic cutaneous (discoid) lupus erythematosus, and dissecting cellulitis. Read More

Br J Dermatol 2017 10;177(4):e160

Division of Dermatology, University of Arizona, Tucson, AZ, U.S.A.

J Am Acad Dermatol 2017 06;76(6):e215-e216

Dermatology Service, Trichology Unit, Ramon y Cajal Hospital, Madrid, Spain; Trichology Unit, Grupo Pedro Jaén, Madrid, Spain.

J Am Acad Dermatol 2017 06;76(6):e213

Dermatology Clinic, University of Catania, Italy. Electronic address:

Pediatr Dermatol 2017 Jul 19;34(4):e210-e211. Epub 2017 Apr 19.

Division of Dermatology, University of Kansas Medical Center, Kansas City, Kansas.

An 18-year-old man presented for evaluation of a 1-year history of painful nodules on the scalp with associated hair loss. Physical examination revealed multiple confluent, fluctuant, boggy nodules on the scalp with overlying alopecic patches. Based on these findings, a diagnosis of dissecting cellulitis of the scalp was made and the patient was successfully treated with oral isotretinoin therapy. Read More

G Ital Dermatol Venereol 2017 06;152(3):324-325

Dermatology Clinic, Sapienza University, Rome, Italy.

Dermatol Surg 2017 05;43(5):738-740

Department of Dermatology, Henry Ford Hospital, Detroit, Michigan.

Actas Dermosifiliogr 2017 10 6;108(8):778. Epub 2016 Dec 6.

Servicio de Dermatología, Hospital Universitario Virgen del Rocío, Sevilla, Spain.

J Am Acad Dermatol 2016 Dec;75(6):1267-1268

Dermatology Service, Trichology Unit, Ramon y Cajal Hospital, Madrid, Spain; Trichology Unit, Grupo Pedro Jaén Clinic, Madrid, Spain.

Exp Dermatol 2017 06 24;26(6):544-547. Epub 2017 Jan 24.

Department of Dermatology and Allergy, Ludwig-Maximilian-University of Munich, Munich, Germany.

Hidradenitis suppurativa/acne inversa is a diverse, enigmatic and distressful disease that has aroused growing interest in specialists from different disciplines. Both names describe its classical manifestations in the intertriginous regions and reflect the historical view of the disease definition, but cause confusions in the understanding of its pathogenesis and classification. In the light of the advance in clinical, histopathological and pathophysiological findings, we propose the term "dissecting terminal hair folliculitis" (DTHF) to characterize its disease nature as folliculitis instead of acneiform disease or apocrine gland disorder. Read More

Int J Trichology 2015 Oct-Dec;7(4):173-5

Department of Pathology, Smt. Kashibai Navale Medical College, Narhe, Ambegaon, Pune, Maharashtra, India.

Perifolliculitis capitis abscedens et suffodiens is the least common of the three conditions included in the follicular occlusion triad. It is one of the causes of scarring alopecia in adult males. Clinically it has to be differentiated from other causes of folliculitis affecting the scalp. Read More

Br J Dermatol 2016 Apr 27;174(4):916-8. Epub 2016 Jan 27.

Department of Dermatology, Heart of England NHS Foundation Trust, Solihull, West Midlands, U.K.

Internist (Berl) 2015 Oct;56(10):1196-208

Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München, Frauenlobstr. 9-11, 80337, München, Deutschland.

Background: Alopecia is the term used to describe hairless areas of the scalp. They can follow a specific pattern, be diffuse or circumscript. Androgenetic alopecia (AGA) follows a pattern: in men thinning of temples and vertex up to total baldness; in women thinning of the midline or parietal area. Read More

Skinmed 2015 May-Jun;13(3):236-8

Curr Probl Dermatol 2015 20;47:76-86. Epub 2015 Feb 20.

Scarring alopecia or cicatricial alopecia results from follicular damage that is sufficient to cause the destruction and replacement of pilosebaceous structures by scar tissue. Primary scarring alopecias represent a group of disorders that primarily affect the hair follicles, as opposed to secondary scarring alopecias, which affect the dermis and secondarily cause follicular destruction. Inflammation may predominantly involve lymphocytes or neutrophils. Read More

Br J Dermatol 2016 Feb 17;174(2):421-3. Epub 2015 Nov 17.

Department of Dermatology, Bichat Hospital, 46 Rue Henri Huchard, Paris, 75018, France.

P R Health Sci J 2015 Jun;34(2):102-4

Board Certified Dermatologist, Private practice San Diego, California.

Dissecting cellulitis of the scalp (DCS) is an uncommon inflammatory disease that often results in scarring alopecia. Numerous therapies have either proved ineffective or only temporarily effective in the management of this condition. Recent reports show adequate responses to tumor necrosis factor (TNF) inhibitors in cases of DCS. Read More

Dermatol Online J 2014 May 16;20(5):22692. Epub 2014 May 16.

Weil Cornell Medical College.

Dissecting cellulitis (DC) also referred to as to as perifolliculitis capitis abscedens et suffodiens (Hoffman) manifests with perifollicular pustules, nodules, abscesses and sinuses that evolve into scarring alopecia. In the U.S. Read More

J Cutan Pathol 2014 Jan;41(1):2-4

Department of Dermatology, Walter Reed National Military Medical Center.

Photodiagnosis Photodyn Ther 2013 Dec 8;10(4):410-3. Epub 2013 Jul 8.

Department of Dermatology, Huashan Hospital, Fudan University, Shanghai 200040, People's Republic of China.

A case of refractory dissecting cellulitis of the scalp (DCS) in a forty-one-year-old Chinese female patient was treated with a total of 6 sessions of topical ALA-PDT at one week intervals. The patient tolerated and responded well to this new approach without any adverse events. This suggested that topical ALA-PDT could be an effective and safe alternative for DCS patients who were refractory to other conventional therapies. Read More

Pediatr Dermatol 2014 Jan-Feb;31(1):e20-1. Epub 2013 Sep 30.

Baylor College of Medicine, Houston, TX.

We report the case of a 16-year-old boy who presented to our clinic with concomitant hidradenitis suppurativa, inflammatory acne, dissecting cellulitis of the scalp, and pyoderma gangrenosum. Recent reports describe the co-occurrence of pyoderma gangrenosum, acne, and hidradenitis suppurativa. This case further expands the spectrum of concomitant pyoderma gangrenosum and dissecting cellulitis of the scalp. Read More

Pan Afr Med J 2013 16;14:151. Epub 2013 Apr 16.

Service de Dermatologie, CHU Ibn Sina, Université Med V, Souissi, Rabat, Maroc.

Acta Derm Venereol 2013 Jul;93(4):473-4

Actas Dermosifiliogr 2013 Jan 31;104(1):92-3. Epub 2012 Jul 31.

Georgian Med News 2012 Apr(205):19-23

Perifolliculitis capitis abscedens et suffodiens (PCAS) is rare chronic, suppurative and inflammatory scalp disease. Its aetiology and pathogenesis is not completely understood. The treatment is usually difficult and often disappointing. Read More

Indian J Dermatol 2011 May;56(3):318-20

Department of Dermatology and Venerology, Trakian University, Medical Faculty, Stara Zagora, Bulgaria.

Folliculitis et perifolliculitis capitis abscedens et suffodiens is a rare disease of unknown etiology. It is a suppurative process that involves the scalp, eventually resulting in extensive scarring and irreversible alopecia. The condition is also known as 'acne necrotica miliaris' or 'Proprionibacterium' folliculitis. Read More

Acta Dermatovenerol Croat 2011 ;19(2):98-102

Department of Dermatology and Venereology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia.

Perifolliculitis capitis abscedens et suffodiens or dissecting cellulitis of the scalp is a rare, chronic destructive folliculitis of the scalp, characterized by painful nodules, purulent drainage, sinus tracts, keloid formation and cicatricial alopecia. The cause of the disease is unknown, but it is similar in many features to hidradenitis suppurativa and acne conglobata. In our case report, the patient's dermatologic appearance included one slightly erythematous, infiltrated alopecic area with draining lesions in the right parietal part of the scalp with a few alopecic areas in other parts of the scalp. Read More

Acta Derm Venereol 2011 Oct;91(6):726-7

Rom J Morphol Embryol 2009 ;50(4):719-24

Department of Dermatology, "Grigore T. Popa" University of Medicine and Pharmacy, Iassy, Romania.

Dissecting cellulitis of the scalp or dissecting folliculitis also known as "perifoliculitis capitis abscedens et suffodiens" (PCAS), is a rare, severe and distinct dermatological disease. It most probably occurs because of follicular occlusion via hyperkeratosis, having the same mechanism of acnea conglobata and hidradenitis suppurativa. These dermatoses may be associated or may have an isolated evolution. Read More

Cutis 2008 Sep;82(3):195-8

Department of Dermatology, University of Athens, Andreas Sygros Hospital, Greece.

Dissecting cellulitis of the scalp, or perifolliculitis capitis abscedens et suffodiens, is an uncommon chronic suppurative disease of the scalp manifested by follicular and perifollicular inflammatory nodules that suppurate and undermine, forming intercommunicating sinuses, and leading to scarring alopecia. Treatment generally fails to obtain a permanently successful result; thus, many therapeutic options have been proposed. We report 4 cases of dissecting cellulitis of the scalp successfully treated with oral rifampicin and oral isotretinoin. Read More

Br J Dermatol 2008 Aug 28;159(2):506-7. Epub 2008 Jun 28.

J Dtsch Dermatol Ges 2008 Jan 1;6(1):44-7. Epub 2007 Oct 1.

Universitäts-Hautklinik Heidelberg, D-69115 Heidelberg.

Perifolliculitis capitis abscedens et suffodiens (PCAS) is a rare scalp disease of unknown etiology which is hard to treat. It is often accompanied by scarring alopecia, acne conglobata, and recurrent fluctuant abscesses. PCAS belongs to the family of acne inversa (hidradenitis suppurativa). Read More

J Cutan Med Surg 2007 Jan-Feb;11(1):35-9

Faculty of Medicine, University of Calgary, Calgary, AB, Canada.

Background: Perifolliculitis capitis abscedens et suffodiens (PCAS) is a suppurative process that involves the scalp, eventually resulting in extensive scarring and irreversible alopecia. This condition often presents in males of African American origin.

Objective: This article describes the clinical presentation, diagnosis, and treatment of an Aboriginal Canadian male suffering from PCAS. Read More

J Eur Acad Dermatol Venereol 2006 Oct;20(9):1143-4

J Eur Acad Dermatol Venereol 2005 Nov;19(6):719-21

Department of Dermatology and Venereology, Zagreb University Hospital Center, Croatia.

Perifolliculitis capitis abscedens et suffodiens (PCAS) is rare chronic, suppurative and inflammatory scalp disease. Its aetiology and pathogenesis is not completely understood. The treatment is usually difficult and often disappointing. Read More

Eur J Dermatol 2003 Mar-Apr;13(2):192-5

Department of Dermatology, School of Medicine, Democritus' University of Thrace, University Hospital of Alexandroupolis, 92 Karaoli and Dimitriou street, Greece.

Perifolliculitis capitis abscedens et suffodiens (or dissecting folliculitis of the scalp or dissecting cellulitis of the scalp or dissecting perifolliculitis of the scalp) is a rare entity and constitutes the equivalent over the scalp, of hidradenitis suppurativa and acne conglobata. Etiologic factors are unknown. Diagnosis is proven histologically. Read More

Dermatol Online J 2003 Feb;9(1)

St-Lukes Roosevelt Hospital Center, New York, USA.

Dissecting cellulitis (also called perifolliculitis capitis abscedens et suffodiens) manifests with perifollicular pustules, nodules, abscesses and sinuses that evolve into scarring alopecia. It predominantly occurs in African American men between 20-40 years of age, but can occasionally affect other races and women too. Associated musculoskeletal findings are sometimes reported. Read More

Eur J Dermatol 2001 Mar-Apr;11(2):155-6

Instituto Dermopatico dell'Immacolata, IDI-IRCCS, Via dei Monti di Creta 104; 00167 Rome, Italy.

Med Sci Monit 2000 May-Jun;6(3):602-4

Department of Dermatology and Venereology, Medical University, ul. Krzemieniecka 5, 94-017 Łódź, Poland.

Perifolliculitis capitis abscedens et suffodiens is a rare suppurative disease of the scalp of unknown aetiology. The treatment is usually difficult and often disappointing. In the case presented in the current work, the remission was achieved with nine-month isotretinoin treatment. Read More

Cutis 1999 Aug;64(2):87-90

Armed Forces Institute of Pathology, Dermatopathology Division, Washington, DC 20306-6000, USA.

A patient with arthropathy associated with cystic acne, hidradenitis suppurativa, and perifolliculitis capitis abscedens et suffodiens who showed a dramatic response to isotretinoin is described. This, to our knowledge, is the first report documenting effective treatment of this condition, whose nosologic position with respect to other spondyloarthropathies associated with cutaneous disease is considered. Read More

Folia Med (Plovdiv) 1994 ;36(4):51-7

Department of Dermatology, University of Medicine, Plovdiv, Bulgaria.

The authors report, for the first time in Bulgarian literature, a case of acne tetrad syndrome in a family. The patients were sisters who were found to have three of the four components of the syndrome: hidradenitis suppurativa, acne conglobata, and cysta pillaris. There was no evidence or anamnestic data for perifolliculitis capitis abscedens et suffodiens. Read More

Ann Dermatol Venereol 1994 ;121(4):328-30

Service de Dermatologie A, Hôpital Claude-Huriez, CHRU, Lille.

Perifolliculitis capitis abscedens et suffodiens is a rare, chronic and suppurative scalp disease. The treatment of this condition is difficult. CASE REPORT. Read More

Arch Dermatol 1992 Oct;128(10):1329-31

Int J Dermatol 1992 Oct;31(10):746

Hautarzt 1992 Sep;43(9):576-9

Dermatologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München.

Erosive pustular dermatosis of the scalp (EPDS), first described in 1979, is a rare, chronic, pustular condition with scarring alopecia, and nonspecific histological findings. While the initial responded to steroids is good, it can be treated successfully by oral administration of zinc sulphate. Local trauma has recently been suggested to play a role in the pathogenesis of EPDS. Read More

Arch Dermatol 1992 Aug;128(8):1115-7, 1118-9

Department of Dermatology, University of Genoa, Italy.

J Dermatol 1992 Jan;19(1):61-3

Department of Dermatology, Texas Tech University Health Sciences Center, Lubbock 79430.

A case of pyoderma vegetans (PYV) and hidradenitis suppurativa (HS) is described. Our patient had a previous history of perifolliculitis capitis abscedens et suffodiens and acne conglobata. Direct immunofluorescence findings ruled out pemphigus vegetans and suggested a potential pathogenic mechanism. Read More

J Am Acad Dermatol 1990 Oct;23(4 Pt 1):752-3

Department of Dermatology, Lund University, General Hospital, Sweden.