COMMUNICATIONS AND BRIEF REPORTS Successful Treatment of Recalcitrant Dissecting Cellulitis of the Scalp With Complete Scalp Excision and Split- Thickness Skin Graft S UPRIYA G. B ELLEW, MD, n R OBERT NEMEROFSKY , MD, w ROBERT A. S CHWARTZ, MD, MPH, n AND MARK S. GRANICK, MD w Departments of n Dermatology and w Plastic Surgery, New Jersey Medical School, Newark, New Jersey BACKGROUND. Dissecting cellulitis of the scalp (DCS) is a therapeutically challenging, chronic, progressive, suppurative disease of the scalp that is of unknown etiology. In addition to causing considerable discomfort and cosmetic disfigurement, long-standing lesions may result in the development of squamous cell carcinoma. Several treatment modalities for DCS have been employed with variable results. OBJECTIVE. To report the successful treatment of an aggressive, refractory case of DCS with complete scalp excision and split- thickness skin graft. METHODS. A 25-year-old black male with DCS was treated with complete scalp excision and split-thickness graft from the anterior thighs. RESULTS. The patient has remained free of disease activity and is satisfied with the cosmetic result. CONCLUSION. Complete scalp excision with split-thickness skin graft may be curative in patients with DCS and should be considered in recalcitrant cases that fail to respond to medical therapy. S. G. BELLEW, MD, R. NEMEROFSKY, MD, R. A. SCHWARTZ, MD, MPH, AND M. S. GRANICK, MD HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. DISSECTING CELLULITIS of the scalp (DCS), also known as perifolliculitis capitis abscedens et suffo- diens, is a therapeutically challenging, suppurative disease of the scalp that is of unknown etiology. It typically occurs in black males between the ages of 18 and 40 and is characterized by tender, fluctuant scalp nodules, intercommunicating sinus tracts between the nodules, and patchy alopecia with scarring. The clinical course of the disease is typically chronic and progressive. 1 Several treatment modalities have been employed for DCS with variable results. Treatment with incision and drainage, X-ray epilation, zinc sulfate, systemic antibiotics, isotretinoin, carbon dioxide laser, pulsed diode laser, and intralesional and oral corticosteroids has been described. 2–13 In 1967, Moschella et al. 14 reported a case of DCS that was managed with therapeutic scalping. In 1986, Williams et al. 15 reported successful treatment of extensive DCS with wide excision and split-thickness skin grafting. In 1987, Ramasastry et al. 2 described a case of DCS complicated by osteomyelitis of the skull treated with extensive debridement and skin grafting. We report a recalcitrant case of DCS successfully treated with complete scalp excision and split-thickness skin graft. Case Report A 25-year-old previously healthy black male presented with a 3-year history of painful, unsightly nodules on his scalp that had gradually increased in number. Physical examination revealed multiple cystic nodules with interconnecting sinus tracts covering the entire scalp (Figure 1). Gentle pressure over the lesions released purulent fluid from multiple follicular orifices. Inflammatory cysts were present in the axillae and the inguinal creases. Results of routine laboratory tests were within normal ranges, except for an elevated C-reactive protein of 45.3 mg/dL (normal range, 0 to 1 mg/dL). Computed tomogram of the head showed no evidence of osteomyelitis. Bacterial culture of the drainage, potassium hydroxide examination, and fungal culture from the scalp were all negative. Treatment with prednisone 40 mg orally daily and cephalexin 500 mg orally four times daily was initiated. Several lesions were incised and drained. New lesions continued to develop and spread to involve the forehead and neck. Prednisone was r 2003 by the American Society for Dermatologic Surgery, Inc.  Published by Blackwell Publishing, Inc. ISSN: 1076-0512/03/$15.00/0  Dermatol Surg 2003;29:1068–1070 Address correspondence and reprint requests to: Robert A. Schwartz, MD, MPH, New Jersey Medical School, Dermatology, 185 South Orange Avenue, MSB H–576, Newark, New Jersey.