Clin Exp Dermatol 2023; 00 :1–3 https://doi.org/10.1093/ced/llad036 Advance access publication date: 26 January 2023 Concise Report Accepted: 24 January 2023 © The Author(s) 2023. Published by Oxford University Press on behalf of British Association of Dermatologists. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com Treatment of dissecting cellulitis of the scalp with tumour necrosis factor inhibitors: a retrospective multicentre study Muslih Alzahrani, 1 Victor Coste, 1 Maria Polina Konstantinou, 2 Ziad Reguiai, 3 Axel Villani, 4 Claire Hotz, 5,6 Manuelle Viguier, 7 Christelle Pruvost-Balland, 8 Alain Dupuy , 8 Pierre Wolkenstein, 6 Aurore Brun, 2 François Aubin 1 and Irène Gallais Sérézal 1 on behalf of the Groupe HS-France de la Société Française de Dermatologie 1 Sce de Dermatologie, CHU et Inserm1098, Besançon, France 2 Sce de Dermatologie, CHU de Toulouse, France 3 Sce de Dermatologie, Clinique Courlancy, Reims, France 4 Sce de Dermatologie, Hospices Civils de Lyon, France 5 Centre Hospitalier Jacques Puel, Rodez, France 6 Sce de Dermatologie, Hôpital Henri Mondor, APHP, UPEC, Créteil, France 7 Sce de Dermatologie, Hôpital Robert-Debré, Université Reims-Champagne Ardenne, Reims, France 8 Sce de Dermatologie, CHU, Rennes, France Correspondence: François Aubin. Email: francois.aubin@univ-fcomte.fr Abstract Although retinoids are considered as the most effective treatment, management of dissecting cellulitis of the scalp (DCS) is often challenging. A multicentre retrospective study was conducted to evaluate the ef fcacy of anti-tumour necrosis factor (TNF) agents in treating DCS after fail- ure of other conventional treatments. Twenty-six patients were included. After a mean treatment duration of 19 months (SD 21), the median Physician’s Global Assessment score decreased from 3 to 1. The median number of infammatory nodules and abscesses decreased from 7 to 0.5 and from 1 to 0, respectively. The median Dermatology Life Quality Index and numerical rating scale score for pain severity decreased from 10 to 8 and 6 to 1, respectively. The median treatment satisfaction was 7 out of 10 on the Patient Satisfaction Index. This study confrms the ef fcacy of anti-TNF agents in treating patients with DCS that is resistant to conventional therapies. Dissecting cellulitis of the scalp (DCS), also known as peri- folliculitis capitis abscedens et suffodiens, or Hoffman dis- ease, is a chronic relapsing dermatosis of the scalp that can result in scarring alopecia if left untreated. 1,2 DCS begins as a follicular pustule on the occipital or vertex scalp that transforms into a painful fuctuant nodule, which may then become multifocal. Many such suppurative nodules may get interconnected by sinuses imparting a boggy appearance to the scalp (Figure 1). Although retinoids are considered as the most effective treatment, 1, 2 management of DCS is often challenging. The use of tumour necrosis factor (TNF) blockers in DCS is based on the hypothesis that chronic infammation may aggravate follicular occlusion by increasing hyperkeratosis. 3 Recently, there have been several reports of patients with DCS being successfully treated with anti-TNF antibodies. 4 Report A multicentre retrospective study was conducted to eval- uate the ef fcacy of anti-TNF agents in treating DCS after failure of other conventional treatments. Clinical ef fcacy was assessed using the Physician’s Global Assessment Scale (PGA) and quantifed according to the number of infammatory nodules and the presence of abscesses. In addition, the Dermatology Life Quality Index (DLQI), and the severity of pain and Patient Satisfaction Index (PSI), both measured using a numerical rating scale (NRS) ranging from 0 to 10, were also used to quantify clinical ef fcacy. Global tolerance was also evaluated. Twenty-six patients (25 males and one female) were included. The mean age at symptom onset was 24 years (SD 10, median 21.5) years. A body mass index of > 30 kg m –2 was observed in 42% of patients, 14 patients smoked (54%), and three patients were cannabis consumers. TNF blockers were introduced as a third-line treatment for almost all patients (24/26). Previous ineffective treatments included systemic antibiotics (92%), isotretinoin (65%) and oral corticosteroids (11%). Five patients were treated with adalimumab (40 mg every 2 weeks) and 21 patients were treated with infiximab starting at a dose of 5 mg kg –1 every 4, 6 or 8 weeks, increased to 7.5 mg kg –1 in six patients, and to 10 mg kg –1 in four patients. Downloaded from https://academic.oup.com/ced/advance-article/doi/10.1093/ced/llad036/7005660 by guest on 21 March 2023