Is This Dissecting Cellulitis of the Scalp in a White Child?
TLDR The case suggests that dissecting cellulitis of the scalp can occur in a White child and should be considered when diagnosing pediatric scarring alopecia.
An 11-year-old White boy presented with a 2-year history of alopecia on the occipital scalp, initially misdiagnosed and ineffectively treated as tinea capitis. The patient exhibited symptoms characteristic of dissecting cellulitis of the scalp (DCS), a condition typically found in adult Afro-Caribbean men, including recurrent pustules, sinus tract formation, scarring, and alopecia due to follicular obstruction. Despite a partial response to erythromycin and oral terbinafine, new alopecic patches appeared. Systemic examination and tests were normal, and the patient was referred for further management, including consideration of isotretinoin. The case highlights the importance of considering DCS in the differential diagnosis of paediatric scarring alopecia, the challenges of histological confirmation in children, the necessity of monitoring disease progression, and the psychosocial impact of discussing permanent hair loss with children and their parents.
