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Table of Contents
CASE REPORT
Year : 2020  |  Volume : 24  |  Issue : 1  |  Page : 52-53

Treatment of refractory dissecting cellulitis of the scalp with guselkumab: Case report


1 Department of Dermatology, University of Connecticut, Farmington, USA
2 Central Connecticut Dermatology, Cromwell, USA
3 Central Connecticut Dermatology, Cromwell; Department of Dermatology, Yale University, New Haven, CT, USA

Date of Submission06-Sep-2019
Date of Acceptance15-Sep-2019
Date of Web Publication27-Mar-2020

Correspondence Address:
Ms. Sonal Muzumdar
University of Connecticut School of Medicine, 21 South Road, 2nd Floor, Farmington, CT06032
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdds.jdds_50_19

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  Abstract 


Dissecting cellulitis (DC) of the scalp is a chronic, clinically refractory inflammatory skin disorder. Herein is a presentation of a male with refractory DC with concurrent hidradenitis suppurativa, who had failed treatment with multiple topical and systemic therapies. After receiving guselkumab, 100 mg subcutaneously every 8 weeks, the patient exhibited marked improvement, with normalization of symptoms and signs.

Keywords: Dissecting cellulitis of the scalp, guselkumab, hidradenitis suppurativa


How to cite this article:
Muzumdar S, Parikh S, Strober B. Treatment of refractory dissecting cellulitis of the scalp with guselkumab: Case report. J Dermatol Dermatol Surg 2020;24:52-3

How to cite this URL:
Muzumdar S, Parikh S, Strober B. Treatment of refractory dissecting cellulitis of the scalp with guselkumab: Case report. J Dermatol Dermatol Surg [serial online] 2020 [cited 2020 Aug 13];24:52-3. Available from: http://www.jddsjournal.org/text.asp?2020/24/1/52/281424




  Introduction Top


Dissecting cellulitis (DC) of the scalp is a chronic, inflammatory skin disorder, which presents with perifollicular nodules, pustules, and abscesses, which can lead to scar formation and alopecia.[1] It is part of the follicular occlusion tetrad along with acne conglobata, hidradenitis suppurativa, and pilonidal cyst.[2],[3] It is most commonly seen in African-American males in their second to fourth decades of life but may occur in persons of any race or gender.[1],[3],[4] Treatment is difficult and relapses are extremely common, resulting in significant psychological distress for patients.[3] Treatments for DC include topical and oral antibiotics, corticosteroids, isotretinoin, and surgery.[1],[3] There have been reports in the literature of DC being treated successfully with tumor necrosis factor-alpha (TNF-α) antagonists, infliximab and adalimumab.[5],[6],[7] Interleukin (IL)-23 inhibitors have not been described in the literature for the treatment of DC; however, ustekinumab and guselkumab have both been used to successfully treat hidradenitis suppurativa.[8],[9] We report a case of marked improvement with normalization of symptoms and signs after receiving guselkumab, 100 mg.


  Case Report Top


A male with a 4-year history of hidradenitis suppurativa, folliculitis, acne conglobata, and pyoderma gangrenosum presented with multiple, painful, and tender fluctuant 1–2 cm nodules diffusely over the scalp, associated with patchy scarring alopecia, consistent with DC. Initially, the patient was successfully being treated with adalimumab 40 mg subcutaneously every week, hydroxychloroquine 200 mg twice daily, doxycycline 100 mg twice daily, prednisone 10 mg once daily, and intermittent topical clobetasol cream and was demonstrating waning clinical response over the past 3 months. Prior treatments included unsuccessful trials of methotrexate and minocycline. Given the lack of control and continued symptoms, the patient was switched from adalimumab to guselkumab 100 mg subcutaneously 4 weeks apart for the first two doses, then every 8 weeks thereafter. All other medications were continued. Six months later, he presented with near-complete resolution of the scalp lesions associated with the resolution of all symptoms. There were no adverse side effects.


  Discussion Top


First-line treatment for mild-to-moderate DC currently includes topical or oral antibiotics and corticosteroids. Isotretinoin also might be effective, albeit with relapses.[1] TNF-α antagonists, including infliximab and adalimumab, are effective for DC.[5],[6],[7] For disease that is refractory to medical therapy, surgical excision of the scalp with split-thickness skin grafting has been effective.[1]

Despite numerous treatment options for DC, relapses are common and often result in significant psychological distress for patients. The patient had failed treatment with oral and topical steroids, oral antibiotics, hydroxychloroquine, methotrexate, and adalimumab. On presentation to our clinic, he displayed worsening skin lesions, pain, and tenderness consistent with a flare of DC. The transitioning of therapy from adalimumab to guselkumab resulted in marked clinical improvement.

While both ustekinumab and guselkumab have been used to successfully treat hidradenitis suppurativa,[8],[9] IL-23 inhibitors have not been reported as effective treatment of DC. However, DC and hidradenitis suppurativa are clinically similar and often can coexist (as in the presented patient). Furthermore, IL-23 is abundantly expressed by macrophages within lesional skin in hidradenitis suppurativa.[9] This may explain this patient's response to guselkumab therapy. Guselkumab, therefore, might represent a viable treatment option for the treatment of DC, possibly more effective in patients with concomitant hidradenitis suppurativa.

Declaration of patient consent

Consent not required as the facial identity of patient has not been revealed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Jerome MA, Laub DR. Dissecting cellulitis of the scalp: Case discussion, unique considerations, and treatment options. Eplasty 2014;14:ic17.  Back to cited text no. 1
    
2.
Veilleux MS, Shear NH. Biologics in patients with skin diseases. J Allergy Clin Immunol 2017;139:1423-30.  Back to cited text no. 2
    
3.
Badaoui A, Reygagne P, Cavelier-Balloy B, Pinquier L, Deschamps L, Crickx B, et al. Dissecting cellulitis of the scalp: A retrospective study of 51 patients and review of literature. Br J Dermatol 2016;174:421-3.  Back to cited text no. 3
    
4.
Casseres RG, Kahn JS, Her MJ, Rosmarin D. Guselkumab in the treatment of hidradenitis suppurativa: A retrospective chart review. J Am Acad Dermatol 2019;81:265-7.  Back to cited text no. 4
    
5.
Navarini AA, Trüeb RM. 3 cases of dissecting cellulitis of the scalp treated with adalimumab: Control of inflammation within residual structural disease. Arch Dermatol 2010;146:517-20.  Back to cited text no. 5
    
6.
Sukhatme SV, Lenzy YM, Gottlieb AB. Refractory dissecting cellulitis of the scalp treated with adalimumab. J Drugs Dermatol 2008;7:981-3.  Back to cited text no. 6
    
7.
Wollina U, Gemmeke A, Koch A. Dissecting cellulitis of the scalp responding to intravenous tumor necrosis factor-alpha antagonist. J Clin Aesthet Dermatol 2012;5:36-9.  Back to cited text no. 7
    
8.
Smith MK, Nicholson CL, Parks-Miller A, Hamzavi IH. Hidradenitis suppurativa: An update on connecting the tracts. F1000Res 2017;6:1272.  Back to cited text no. 8
    
9.
Schlapbach C, Hänni T, Yawalkar N, Hunger RE. Expression of the IL-23/Th17 pathway in lesions of hidradenitis suppurativa. J Am Acad Dermatol 2011;65:790-8.  Back to cited text no. 9
    




 

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