DISSECTING CELLULITIS (FOLLICULITIS) OF THE SCALP
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Had a recent patient with dissecting cellulitis of the scalp 
that states he did well for several years after phototherapy (sounds 
like PUVA) which was done to treat his scalp problem. Sounded interesting, but 
I couldn't find any reports. Any one heard of this therapy for 
dissecting cellulitis? Anyone found a "cure" they like for these 
patients?

I follow occasional cultures, use po antibiotics (minocin/tcn 
usually), IL kenalog, I&D of large lesions,... and find it all 
very unrewarding in most of these patients. Had a great response with 
Zinc po with the first patient I tried it on and no improvement with 
the next 5 or 6 patients I tried it on.
     
Mark Crowe MD
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I had a pre-med who got better when I got him to stop injecting himself with
anabolic steroids - make sure this guy is not doing that. I've seen resistant
acne with anabolics too.

I'd try Zithromax [for super-high tissue levels] together with Rifampin. 

If that didn't work I'd add cyclosporine 5 mg/kg to settle down the
inflammation, and keep on with the Abx.


KC Smith MD FRCPC
Niagara Falls ON
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In answer to the next step for dissecting cellulitis when all else had
failed, try Dapsone. This is what we used before Accutane, usually
successfully. 

Diane Thaler MD
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You might try dapsone (if he has g6pd) or metronidazole.

Steve Emmet
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I don't give up on antibiotics for dissecting cellulitis of the scalp 
until the patient has been on Bacrim DS bid for at least 6 wk; it has 
always worked better than Minocycline for me. Allergic reactions are a 
problem, though.   

John Uhlemann
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I have had the best luck with a combination of long term (months) oral 
antibiotics, aggressive IL steroids (2.5 mg/ml in lidocaine with epi is 
what I usually use--6-12 ml at a time--watch out for beta blockers), 
and both topical steroid solutions (usually Synalar) and topical 
antibiotics (usually Cleocin). The combined approach works much better 
than single agents. Also warn strictly against oily pomades which can 
exacerbate and consider a 1-4 month trial of Accutane if all else 
fails. Microbiologic data is useless, because it is not a primary 
bacterial disease dissecting "cellulitis" is really a misnomer. 

Mark Naylor, M.D.
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The most effective therapy that I have found in multiple patients with
dissecting cellulitis of the scalp, some of whom have also had nodulocystic
acne has been Accutane at 1-1.5mg/kg. It sometimes requires 6 months of
therapy to completely suppress.
 
John L. Jennings, Jr., MD
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				4.17.96