Dissecting Cellulitis of the Scalp: Linking Pathogenesis to Therapy

Dissecting Cellulitis of the Scalp (DCS) is a chronic inflammatory disorder leading to scarring alopecia, primarily affecting young adult men with darker skin. Traditional treatments like systemic retinoids and antibiotics often provide limited relief, prompting interest in biologic therapies targeting TNF-α, IL-17, and IL-23 pathways, as well as JAK inhibitors. These biologics show promise, especially for moderate-to-severe or treatment-resistant cases. A systematic review of 57 studies found a 54% significant improvement rate with isotretinoin, but a 19% relapse rate. TNF-α inhibitors, such as infliximab and adalimumab, have shown promise in reducing inflammation and symptoms in severe cases. The document emphasizes a stepwise, phenotype-driven treatment approach, with systemic retinoids as first-line therapy and biologics as viable options for refractory cases. Future research should focus on standardized trials and biomarker-informed treatment strategies to enhance remission durability.