Overview
Cotyledonoid dissecting leiomyoma, also known as dissecting cellulitis of the scalp or perifolliculitis capitis abscedens et suffodiens (PCAS), is a rare, severe neutrophilic cicatricial alopecia characterized by deep inflammatory infiltrates, abscess formation, and destruction of polysebaceous follicles 3.Diagnosis
Clinical Features: Multiple interconnected alopecic nodules, particularly on the vertex scalp, with relapsed inflammatory nodular lesions and follicular pustules 32.
Histopathology: Deep inflammatory infiltrate in the reticular dermis or subcutis, formation of abscesses, and destruction of polysebaceous follicles with lymphoplasmacytic granulomas 3.
Comorbidities: Often associated with acne conglobata and hidradenitis suppurativa 123.
Radiographic Findings: Asymptomatic radiographic sacroiliitis may be present in some cases 1.Management
First-Line Treatments:
- Systemic Antibiotics: Azithromycin, tetracycline, ciprofloxacin (specific doses not detailed) 3.
Adjunctive Treatments:
- Topical Agents: Not specifically detailed in provided abstracts.
- Surgical Interventions: May be considered for severe cases with extensive scarring 2.Special Populations
Comorbid Conditions: Patients with acne conglobata and hidradenitis suppurativa may have an increased risk 123.
No Specific Data: Limited information on management in pregnancy, pediatrics, or elderly populations 123.Key Recommendations
Histopathologic Confirmation is Essential for Diagnosis (Evidence: Moderate 3).
Consider Systemic Antibiotics for Treatment, especially in cases with significant inflammatory activity (Evidence: Weak 3).
Monitor for Associated Spondyloarthropathies, particularly in patients with chronic scalp lesions (Evidence: Moderate 1).References
1 Zagelbaum Ward NK, Jun JA, Vecerek N, Donaldson M, Quismorio FP. Dissecting cellulitis of the scalp associated with peripheral and axial spondyloarthritis: report of a case and review of the literature. Clinical rheumatology 2022. link
2 Lee CN, Chen W, Hsu CK, Weng TT, Lee JY, Yang CC. Dissecting folliculitis (dissecting cellulitis) of the scalp: a 66-patient case series and proposal of classification. Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG 2018. link
3 Brănişteanu DE, Molodoi A, Ciobanu D, Bădescu A, Stoica LE, Brănişteanu D et al.. The importance of histopathologic aspects in the diagnosis of dissecting cellulitis of the scalp. Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie 2009. link