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Excisional surgery (scalpectomy) for dissecting cellulitis of the scalp.

The scalp condition was nonresponsive to trials of oral prednisone and topical and oral clindamycin before presentation to our clinic. Local incision and drainage of lesions and intralesional steroids provided temporary symptomatic relief. He completed two courses of systemic isotretinoin with minimal improvement and failed several months of etanercept, an anti-tumor necrosis factor alpha (TNF-a) inhibitor. Radiation-induced epilation was considered, but his insurance carrier did not approve it. Because the scalp disorder was progressing, disfiguring, and a social stigma for him, he underwent total scalp excision (Figures 1 and 2) followed by split-thickness skin grafting (Figure 3) for definitive therapy. He tolerated the procedure well, experienced relief of symptoms, and was pleased with his final outcome (Figure 4).