Dissecting cellulitis of the scalp (DCS) is a chronic, inflammatory scalp condition that causes painful boggy nodules, abscesses, and sometimes draining sinus tracts. Over time, it can lead to scarring hair loss (cicatricial alopecia). It’s also known as perifolliculitis capitis abscedens et suffodiens (Hoffman disease).
Medical note: This article is for general education and does not provide personal medical advice. For the full site roadmap, start here: Hair Loss (Complete Guide).
Quick navigation
- What it is (plain English)
- What it usually looks like
- Who gets it & related conditions
- Why it happens (what we know)
- How it’s diagnosed
- Treatment overview
- What to do (safe next steps)
- When to see a doctor
- FAQ
- References
What is dissecting cellulitis of the scalp?
DCS is part of the neutrophilic scarring alopecias. In simple terms, it’s an inflammatory disease centered around hair follicles that can cause:
- Deep tender bumps (nodules) and abscesses
- Pus or drainage, sometimes from more than one opening
- Sinus tracts (channels under the skin that connect lesions)
- Scarring hair loss in areas of long-standing inflammation
On this site, DCS belongs under: Scarring Alopecia (Hub) → Primary Scarring Alopecia and the big-picture map: Types of Hair Loss.
What it usually looks like
DCS often affects the vertex (top) and can spread toward the occipital scalp (back). Common features include:
- Painful, boggy swellings (deep “spongy” lumps)
- Recurrent abscesses that may drain
- Crusting and tenderness
- Patchy hair loss that can become permanent in scarred areas
Common “look-alikes” (important)
- Folliculitis decalvans (FD): pustules/crusting with tufted hairs; can overlap clinically.
Read: Folliculitis Decalvans. - Discoid lupus (DLE): scaly plaques, pigment change; biopsy can help differentiate.
Read: Discoid Lupus (DLE). - LPP/FFA: perifollicular scale/erythema; often itch/burning; usually not dominated by draining abscesses.
Read: LPP + FFA. - Tinea capitis: scaling + broken hairs/black dots (especially in children).
Read: Tinea Capitis.
Who gets it & related conditions
DCS is considered uncommon, but when it occurs, it is often described in young adult males. It is part of the follicular occlusion spectrum, and some people also have related conditions such as:
- Hidradenitis suppurativa (HS)
- Acne conglobata
- Pilonidal disease
This “clustering” matters because it can influence treatment strategy and how aggressively inflammation is controlled.
Why it happens (what we know)
Most modern reviews describe DCS as a disorder where follicular occlusion and inflammation lead to rupture, abscess formation, and chronic tunnels (sinus tracts). It is not simply a “regular infection,” and it is not considered contagious.
How it’s diagnosed
Diagnosis is usually clinical, supported by close scalp examination. Depending on the case, clinicians may use:
- History + exam: pain, drainage, recurrent nodules, distribution (vertex/back)
- Trichoscopy (scalp dermoscopy): helpful patterns may support an inflammatory/scarring process
- Culture: sometimes used when drainage is present (to guide targeted antibiotics)
- Scalp biopsy: used when diagnosis is uncertain or to distinguish from other scarring alopecias
Site guides: How Hair Loss Is Diagnosed • Scalp Biopsy
Treatment overview
Treatment is individualized. The main goal is to reduce inflammation, prevent new abscesses/sinus tracts, and protect remaining follicles. Reviews and patient leaflets commonly discuss options such as:
- Antibiotics (often for anti-inflammatory effect and/or secondary infection control)
- Oral isotretinoin in selected patients (especially refractory disease; clinician-directed)
- Corticosteroids (topical/intralesional in selected cases)
- Biologics (e.g., TNF-alpha inhibitors) in severe, resistant disease (specialist care)
- Procedures in advanced disease (e.g., drainage, laser hair removal, or surgical approaches in selected cases)
Important: If you have draining lesions, avoid repeated “random antibiotics” without assessment—ask about culture-guided treatment and a plan to control chronic inflammation.
For the site’s general framework, see: Treatment Overview.
What to do (safe next steps)
- Book a dermatology visit early: painful nodules/drainage with hair loss can be scarring—early control matters.
- Don’t squeeze or pick: trauma can worsen inflammation and scarring.
- Ask about cultures: especially if there is pus/drainage (to guide targeted therapy).
- Track activity: photos every 2–4 weeks (same lighting) help document response.
- Screen for related conditions: mention HS/acne conglobata/pilonidal disease if present.
When to see a doctor (red flags)
- Rapidly worsening pain or swelling
- Spreading drainage, foul odor, or extensive crusting
- Fever or feeling unwell
- Shiny smooth patches or visible loss of follicle openings (possible scarring)
Read: When to See a Doctor.
FAQ
Is dissecting cellulitis contagious?
No. It is not considered contagious. It is a chronic inflammatory follicular disease; bacteria can be involved, but it’s not “caught” like a typical infection.
Can hair grow back?
Regrowth is more likely in early areas that have not scarred. Once follicles are replaced by scar tissue, regrowth is limited. Treatment focuses on stopping progression.
Is it the same as folliculitis decalvans (FD)?
No—DCS and FD are different entities, though both can produce pustules/crusting and scarring. DCS tends to be deeper with boggy nodules and sinus tracts; FD often features tufted hairs. See: Folliculitis Decalvans.
References (trusted medical sources)
- DermNet: Perifolliculitis capitis abscedens et suffodiens (Dissecting cellulitis)
- British Association of Dermatologists (BAD): Dissecting cellulitis of the scalp (patient leaflet)
- Cuellar et al (2020): Dissecting cellulitis of the scalp—review (PMC)
- Frątczak et al (2022): Dissecting cellulitis overview (PMC)
Last updated: February 05, 2026.
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