isotretinoin and Cellulitis

Perifolliculitis capitis abscedens et suffodiens (PCAS) is a rare, suppurative dermatosis of the scalp, the etiology of which remains unknown. It is characterized by the development of comedones, perifollicular pustules, firm or fluctuant and itchy or painful nodules and abscesses of the scalp, connected by communicating sinuses that may lead to the formation of scarring and irreversible alopecia. Treatment of PCAS is challenging, often leading to unsatisfactory results. We present a case of a 23-year-old Caucasian man with PCAS who was treated successfully with systemic isotretinoin monotherapy and we review the current therapeutic options.

Topics: Adult; Cellulitis; Dermatologic Agents; Humans; Isotretinoin; Male; Scalp Dermatoses; Young Adult

Dissecting cellulitis of the scalp is a primary scarring alopecia. Isotretinoin is commonly referenced in the literature as a treatment for dissecting cellulitis. The objective of this article was to conduct a review and meta-analysis to assess the efficacy of isotretinoin for treating dissecting cellulitis of the scalp.. The following databases were searched for articles prior to 23 June, 2019: PubMed, Embase, Cochrane Central, CINAHL, and Web of Science. Multi-patient studies (more than three) that reported on the administration of isotretinoin for dissecting cellulitis were included. A pooled meta-analysis for improvement of disease burden after isotretinoin administration in patients with dissecting cellulitis of the scalp was performed. A fixed-effects model was used.. Five articles were ultimately used for the quantitative meta-analysis. The overall efficacy rate of isotretinoin in treating dissecting cellulitis of the scalp was estimated to be 0.9 with a 95% confidence interval (0.81-0.97). The sensitivity analysis suggested that the overall efficacy is still very high, with a range of 0.83-0.94. Recurrence was seen in 24% (6/25) of patients. Common associated diseases amongst patients with dissecting cellulitis of the scalp were acne conglobata 20% (30/151) and hidradenitis suppurativa 19% (11/72).. Isotretinoin is an effective treatment for improving symptoms of dissecting cellulitis of the scalp. Disease recurrence is a common finding for those who undergo successful treatment.

Topics: Adolescent; Adult; Alopecia; Cellulitis; Child; Dermatologic Agents; Female; Humans; Isotretinoin; Male; Middle Aged; Recurrence; Retrospective Studies; Scalp Dermatoses; Treatment Outcome; Young Adult

Dissecting cellulitis is a chronic inflammatory dermatosis that results in disfiguring and painful, purulent lesions. Treatment of patients with disease resistant to standard therapies, including intralesional or topical steroids or antibiotics, can be a dilemma for clinicians.. We performed a systematic review of the literature in November 2018 to find articles which presented treatment options and outcomes of patients who failed prior treatment with standard therapies.. We identified 57 articles of interest, with 53 being case studies or series. Isotretinoin was the most often reported, but the response was limited. Biologics and laser therapy were used less often but demonstrated a better chance of remission. X-ray epilation and surgical excision demonstrated the best remission rates but can be complicated by serious morbidity.. We propose a regimen for the treatment of recalcitrant cases of dissecting cellulitis. In the future, more robust studies including randomized control trials are needed to identify the preferred treatment options for refractory dissecting cellulitis.

Topics: Adalimumab; Anti-Bacterial Agents; Cellulitis; Humans; Isotretinoin; Lasers, Gas; Lasers, Solid-State; Photochemotherapy; Scalp Dermatoses; Skin Diseases, Genetic; Steroids

Topics: Adolescent; Adult; Age of Onset; Cellulitis; Dermatologic Agents; Disease Progression; Female; Humans; Isotretinoin; Male; Middle Aged; Retrospective Studies; Scalp Dermatoses; Skin Diseases, Genetic; Young Adult

Dissecting cellulitis is an uncommon, chronic, progressive suppurative disease of unknown etiology. It is characterized by painful papules and nodules, interconnecting sinus tracts, purulent drainage, and scarring alopecia. This disease predominately affects young black men, but is rarely reported in white males. The refractory nature of this process makes treatment difficult. We report a case of dissecting cellulitis in a white male, which responded to oral isotretinoin.

Topics: Administration, Oral; Adult; Cellulitis; Humans; Isotretinoin; Male; Scalp Dermatoses

Dissecting cellulitis (DC) is a chronic inflammatory primary neutrophilic scarring alopecia. It predominantly affects the vertex and occipital regions of Afro-descendent men. Female DC is uncommon, and little is known about this condition in childhood. This paper reports a pediatric female case of DC with an excellent therapeutic response to low-dose oral isotretinoin.

Topics: Alopecia; Cellulitis; Child; Chronic Disease; Female; Humans; Isotretinoin; Scalp Dermatoses

Topics: Cellulitis; Humans; Isotretinoin; Scalp Dermatoses

Dissecting folliculitis (DF) or dissecting cellulitis of the scalp is regarded as a rare disease with disfiguring scarring alopecia. This study aimed to analyze the features of DF and to propose a classification to define its severity.. A hospital-based retrospective study was conducted. Patients with a histopathological diagnosis or clinical features leading to diagnosis of DF were included and classified into three stages.. Among the 66 patients recruited (63 men / 3 women, mean age 24.9 years), multiple interconnected alopecic nodules involving the vertex scalp were the main feature. Histopathology showed an extensive inflamed granulation abscess forming a dissection plane in the lower dermis/subcutis in the acute stage. Lymphocytic infiltration was predominant in seven of 21 histology specimens. Overweight and obesity were noted in 29 of 45 patients examined. No association with smoking was found. There was comorbidity with acne conglobata in 15 of 66 patients, two of whom had acne inversa. Longer disease duration and greater number of nodules were associated with higher severity of DF (p < 0.05). A complete remission rate of 25 % was achieved by any treatment, and a rate of 37.5 % was achieved with oral isotretinoin alone.. DF is not uncommon in Taiwan. An association with obesity needs to be clarified.

Topics: Abscess; Acne Vulgaris; Adult; Alopecia; Cellulitis; Comorbidity; Female; Granulation Tissue; Humans; Isotretinoin; Lymphocytosis; Male; Obesity; Overweight; Retrospective Studies; Scalp; Scalp Dermatoses; Skin Diseases, Genetic; Treatment Outcome

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.

Topics: Adolescent; Alopecia; Cellulitis; Humans; Isotretinoin; Male; Scalp; Scalp Dermatoses; Skin Diseases, Genetic

Topics: Adult; Cellulitis; Dermatologic Agents; Drug Eruptions; Drug Substitution; Humans; Isotretinoin; Male; Scalp Dermatoses; Skin Diseases, Genetic; Testosterone Congeners; Treatment Outcome

Topics: Adolescent; Adult; Biopsy; Cellulitis; Dermatologic Agents; Female; Global Health; Humans; Isotretinoin; Male; Middle Aged; Morbidity; Multicenter Studies as Topic; Retrospective Studies; Scalp; Scalp Dermatoses; Skin Diseases, Genetic; Spain; Young Adult

Dissecting cellulitis of the scalp is a chronic, relapsing, inflammatory disease of the scalp that results in scarring alopecia. We present a case of a 32-year-old man with recalcitrant disease who is now responding to treatment with isotretinoin. The pathogenesis, clinical presentation, disease associations, and histopathological findings are reviewed. Treatment can be challenging. The literature on medical and surgical therapeutic options is reviewed.

Topics: Adult; Alopecia; Cellulitis; Dermatologic Agents; Humans; Isotretinoin; Male; Methicillin-Resistant Staphylococcus aureus; Scalp Dermatoses; Staphylococcal Infections

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. To our knowledge, this is the first report of oral rifampicin used concomitantly with oral isotretinoin in this disease entity. We also present a brief review of the literature on the topic.

Topics: Administration, Oral; Adult; Cellulitis; Dermatologic Agents; Diagnosis, Differential; Drug Therapy, Combination; Enzyme Inhibitors; Humans; Isotretinoin; Male; Rifampin; Scalp Dermatoses

Dissecting cellulitis of the scalp (DCS) is a suppurative, neutrophillic dermatosis. Therapies typically provide short-term improvement and include antibiotics, prednisone, and isotretinoin, as well as radiation, surgical excision, and laser ablation. The authors report the use of the tumor necrosis factor (TNF) blocker, adalimumab, to successfully treat a 39-year-old male with a long-standing history of DCS.

Topics: Adalimumab; Anti-Inflammatory Agents; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Cellulitis; Cicatrix; Humans; Isotretinoin; Keratolytic Agents; Male; Middle Aged; Scalp; Skin; Tumor Necrosis Factor-alpha

Topics: Adult; Cellulitis; Chest Pain; Dermatologic Agents; Humans; Isotretinoin; Male; Recurrence; Scalp Dermatoses

Topics: Adult; Cellulitis; Dermatologic Agents; Humans; Isotretinoin; Male; Scalp Dermatoses

Topics: Adult; Anti-Bacterial Agents; Cellulitis; Clindamycin; Dermatologic Agents; Humans; Isotretinoin; Male; Peptostreptococcus; Prevotella intermedia; Scalp Dermatoses

Topics: Adult; Cellulitis; Dermatologic Agents; Humans; Isotretinoin; Male; Scalp Dermatoses; Treatment Outcome

Topics: Adult; Cellulitis; Drug Administration Schedule; Humans; Isotretinoin; Keratolytic Agents; Male; Remission Induction; Scalp Dermatoses; Treatment Outcome

Isotretinoin, an effective therapy for nodulocystic acne and dissecting cellulitis of the scalp, has many known side effects. However, its association with elevated creatine kinase levels and its potential to cause rhabdomyolysis is not well established. We describe a patient with a significant elevation in creatine kinase after beginning therapy with isotretinoin for dissecting cellulitis of the scalp. The implications of isotretinoin causing rhabdomyolysis are discussed.

Topics: Cellulitis; Humans; Isotretinoin; Male; Middle Aged; Rhabdomyolysis; Scalp Dermatoses

We report three patients with dissecting cellulitis of the scalp. Prolonged treatment with oral isotretinoin was highly effective in all three patients. Furthermore, long-term post-treatment follow-up in two of the patients has shown a sustained therapeutic benefit.

Topics: Adult; Black or African American; Cellulitis; Follow-Up Studies; Humans; Isotretinoin; Keratolytic Agents; Male; Scalp Dermatoses

Topics: Acne Vulgaris; Administration, Oral; Adult; Cellulitis; Edema; Facial Dermatoses; Humans; Isotretinoin; Male; Staphylococcal Skin Infections

Topics: Adult; Cellulitis; Family Health; Humans; Isotretinoin; Male; Scalp Dermatoses; Staphylococcal Infections

Topics: Adult; Cellulitis; Humans; Isotretinoin; Male; Scalp Dermatoses; Tretinoin