Table 1 Characteristics of clinical studies on Tumor necrosis factor-α blockers, anti-interleukins, and small molecule inhibitors in the treatment of dissecting cellulitis of the scalp

Islam, 2024 [34]

Case report

1

M

26

Obesity and atopic dermatitis

Enlarging, painful cysts,

Elevated ESR, CRP, and IL-6

11 months

benzoyl peroxide 10%, sulfamethoxazole-trimethoprim 800–160 mg twice daily, oral and intralesional corticosteroids

Upadacitinib

15 mg twice daily

Topical antimicrobials, oral antibiotics, and corticosteroid injections

Clinical signs and symptoms

Substantial improvement in pain, pustular draining, bleeding, and quality of life, fewer pustules, smaller sinus tracts, and decreased inflammation with no visible drainage

No major side effects

NA

Nagshabandi, 2023 [33]

Case report

2

M

Pt1: 26

Pt2: 17

Pt1: type 2 diabetes, sleeve gastrectomy

Pt2: NA

Pt1: multiple erythematous draining nodules with few pustules, and scarring alopecia patches

Pt2: few erythematous nodules with hair regrowth mainly over the occipital scalp and crown a solitary alopecic patch over the right temporal area and occipital scalp, miniaturized hair with few yellowish globules on dermatoscopic evaluation

Pt1: 2 years

Pt2: 5 years

Pt1: topical clindamycin 1% solution and oral doxycycline 100 mg

Pt2: topical clindamycin solution, doxycycline 100 mg for 6 months, oral clindamycin 150 mg, oral rifampicin 300 mg, which increased to 600 mg, topical minoxidil 5%, oral zinc sulfate

Risankizumab

SC injection

Pt1: NA

Pt2: topical clindamycin 1% solution daily

Clinical signs and symptoms

Pt1: an improvement of roughly 70% of lesions by the fifth dose of risankizumab

Pt2: clinical remission by the third dose of risankizumab

NA

NA

Bernard, 2023 [35]

Case report

1

M

54

Epilepsy, hyperlipidemia, diabetes mellitus, and hypertension

Several fluctuant, tender nodules throughout the posterior and vertex scalp

5 years

erythromycin and minocycline, trimethoprim-sulfamethoxazole 800/160 mg twice a day for 2 months, minocycline 100 mg twice daily for 3 months, dapsone 100 mg daily for 6 months, and isotretinoin 80 mg daily for 4 months, 1% clindamycin solution for 4 months, 2.5% selenium sulfide 2.5% wash for 1 year, 0.05% fluocinonide solution for 2 months, adalimumab 80 mg every 14 days for 5 months, intralesional corticosteroids, surgical treatment

Apremilast

30 mg twice daily

One in-clinic surgical deroofing procedure

Clinical signs and symptoms

Dramatic improvement of disease symptoms and reduction in flares

No adverse events

The patient remains on 30 mg of apremilast twice daily with sustained improvement of his DCS with additional procedures

Yu, 2023 [51]

Case report

1

M

15

BMI = 26.2, smoking, FH of skin appendage disorders

Several fluctuating pustules and prominent erythematous nodules on the scalp, interconnecting sinuses filled with malodorous pus, and extensive alopecia patches

10 months

Antibiotic treatment with oral minocycline (50 mg twice daily) for 3 months and oral clindamycin (0.15 g four times daily) for 1 month, operation to remove the abscess and drain the pus

Adalimumab and baricitinib 80 mg adalimumab on day 0, followed by 40 mg every 2 weeks, reduced to every 4 weeks after 4 months

Baricitinib 4 mg daily started at month 4, which was reduced to 4 mg every 3 days 2 months later

Minocycline (50 mg twice daily), isotretinoin (30 mg daily), which was discontinued after 4 months, fenofibrate (200 mg daily) at month 4

Laboratory tests, clinical signs and symptoms, hair regrowth

Improvement of the scalp with a drop in the number of fresh pustules and less drainage, alopecia patches became scattered, tenderness subsided, hair regrowth, control of inflammation, leukocyte and neutrophil counts altered from 12.7 × 10^9 and 9.1 × 10^9 to 6.9 × 10^9/L, 3.5 × 10^9/L respectively, and lymphocyte changed from19.8% to 39.1%, CRP concentration dropped from 3.38 mg/L. to 1.73

Elevated triglycerides and cholesterol levels (related to adalimumab)

NA

Alzahrani, 2023 [43]

Cohort study

26

M: 96%

24 ± 10

BMI > 30 (42%), cigarette smoking (54%), cannabis consumption (11%)

NA

NA

Systemic antibiotics (92%), isotretinoin (65%) and oral corticosteroids (11%)

Infliximab and adalimumab (anti-TNFα)

For 19 months

Adalimumab (n = 5, 19.2%) 40 mg every 2 weeks and infliximab (n = 21, 80.8%) 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

NA

PGA, number of inflammatory nodules and abscesses, DLQI, PSI

The median PGA score decreased,The median number of inflammatory nodules and abscesses decreased,

The median DLQI and the NRS score for pain severity decreased,

The median PSI was 7 out of 10

Optic neuritis (n = 1, after 3 months of treatment) and hepatic cytolysis (n = 1 after the ninth perfusion)

2 patients were in remission, 3 demonstrated moderate efficacy and 1 was lost to follow-up

Almuhanna, 2023 [62]

Case report

1

F

33

Pregnancy (12 weeks)

Diffuse, boggy, hyperkeratotic, and atrophic plaques with overlying crust and scattered alopecic patches on scalp

5 years

Topical and systemic antibiotics, systemic corticosteroids, isotretinoin

Certolizumab pegol

SC loading dose: 400 mg at weeks 0, 2, and 4, 200 mg every other week

Cephalexin 500 mg, 2 times a day for 10 days

Clinical signs and symptoms

70% improvement of lesions, with less pruritus, tenderness, erythema, purulent discharge, crustation, and reduction in the frequency of new lesions (after 4 months)

Tolerable with no adverse reactions

Sustained treatment response (after 8 months, 4 weeks postpartum), remained on certolizumab 200 mg every 2 weeks

Koike, 2022 [20]

Case report

1

M

21

NA

Elastic, soft, SC walnut-sized nodules with purulent secretion and geographic hair loss in the occipital region, soft tissue inflammation of the scalp, An IHS4 score of 65 points, elevated white blood cell counts and serum CRP

6 years

Oral minocycline, surgical treatment

Adalimumab An initial dose of 160 mg, tapering to 80 mg and then to 40 mg every 2 weeks

NA

IHS4, clinical signs and symptoms

A decrease in IHS4 from 22 to 7 points, after 1 month of treatment and to 3 points after 4 months

Flattening of the scalp lesion and hair regrowth

Deacreased serum level of IL-1RA, IL-1b, MCP-3, MCP-1, MIP-1a, IL-8 and FGF-2 after 3 months of adalimumab treatment

NA

NA

Gamissans, 2022 [42]

Cohort study

3 (a total of 14 patients, 3 receiving anti-TNFα)

M

39.6 ± 9.8

Median BMI = 28.5 kg/m2, smoking (64%, n = 9), HS (86%, n = 12)

DCS stage II or III (79%, n = 11) lesions predominated on the vertex (100%, n = 14) occipital area (50%, n = 7)

NA

NA

Adalimumab and Infliximab (anti-TNFα)

For 9.33 ± 3.77 months, 66.6% (n = 2) adalimumab 80 mg/2 weeks, infliximab 33.3% (n = 1) 0.5 mg/kg/month

Topical or oral antibiotics or intralesional steroid injection

Hair regrowth and absence of a bald area

Complete response (66.6%, n = 2) and partial response (33.3%, n = 1)

Infusion reaction leading to treatment withdrawal (33%, n = 1)

0% recurrence rate

Babalola, 2022 [63]

Case report

1

M

65

Congestive heart failure (ejection fraction of 45%), coronary artery disease, hyperlipidemia, hypertension, and non-alcoholic fatty liver disease

Recurrent itchy bumps, persistent draining nodules on the scalp, multiple tenders, crusted lesions with suppurative drainage on the parietal and occipital scalp, severe mucocutaneous dryness

13 years

Topical clindamycin, doxycycline 100 mg BID, intermittent intralesional triamcinolone, chlorhexidine gluconate, fluocinonide, and isotretinoin 30 mg BID

Risankizumab 150 mg every 12 weeks

NA

Clinical signs and symptoms

Well response to treatment

NA

NA

Awad, 2022 [64]

Case report

1

M

28

HS, AC

Several large, fluctuant, tender nodules on the scalp with overlying alopecia

NA

Isotretinoin 20 mg, erythromycin 500 mg, and intralesional triamcinolone injections

Tildrakizumab (IL-23 inhibitor)

For 8 weeks, 2 doses of SC injection 4 weeks apart

NA

Clinical signs and symptoms, number and severity of pustules and scalp tenderness,

hair regrowth

Significant reduction in the number and severity of pustules and alleviated scalp tenderness along with hair regrowth in the areas of alopecia

NA

NA

Sanchez-Diaz, 2021 [48]

Case series

2 (a total of 8 patients, 2 with DCS receiving anti-TNFα)

M

Pt1: 48

Pt2: 45

Pt1: BMI 39.4, HS

Pt2: BMI 48.97, smoking

Pustules, nodules, abscesses, scars, and fistulas

on the scalp

Pt1: 480 weeks

Pt2: 432 weeks

Pt1: doxycycline, clindamycin-rifampicin, isotretinoin, photodynamic

therapy, adalimumab

Pt2: doxycycline, rifampicin, isotretinoin, acitretin

Pt1: infliximab (anti-TNFα)

5 mg/kg every 8 weeks

Pt2: adalimumab (anti-TNFα)

80 mg every 2 weeks

Pt1: dapsone (100 mg/day), ertapenem (1 g IM/24 h)

Pt2: NA

NRS pain, NRS pruritis, NRS suppuration, Hurley, IHS4, AN, HiSCR

HiSCR achieved. a significant decrease in NRS pain, NRS pruritis, NRS suppuration, Hurley, IHS4, and AN

NA

Pt1: satisfactory response and reached HiSCR in follow-up after 24 weeks

Pt2: satisfactory response and reached HiSCR in follow-up after 32 weeks

Spiers, 2021 [50]

Case report

1

M

34

NCA, ankylosing spondylitis, cigarette smoking

Severe dissecting scalp cellulitis, type VI skin, soft boggy swellings and abscesses affecting the scalp, worse in the occipital region (the largest: 6 × 3 cm), new lesions and interconnected sinuses in the parietal and occipital area, all discharging pus

NA

A three-month course of rifampicin 300 mg and clindamycin 300 mg, both twice daily, and a 4-month course of oral isotretinoin, 4 staged procedures of incision, drainage, and excision of scalp lesions, with the wounds being packed and left to heal by secondary intention

Adalimumab

40 mg fortnightly from 14 months before the surgical procedure to 8 months after it

Surgical management (two further staged procedures: incision, drainage, and excision of large areas of scalp under general anesthetic)

DLQI, clinical signs and symptoms

Self-report of 10–15% improvement (while on adalimumab before surgery), DLQ1 dropped from 14/30 to 2/30, complete healing of the scalp without discharge (after surgery)

NA

No further discharge or episodes in one-year follow-up

Minakawa, 2021 [52]

Case report

1

M

30

Smoking (10 years), BMI = 30.49, HS

Multiple soft subcutaneous nodules with oozing, purulent secretions from fistulas all over scalp and face, patchy hair loss, massive diffuse lymphocytic infiltration in the dermis on biopsy, perivascular and perifollicular areas, T cell infiltration was visualized using the pan-T cell marker CD3, but TNF- was negative

12 years

Minocycline 200 mg/day for 4 years, Nadifloxacin, Benzoyl peroxide, and Clindamycin phosphate

Adalimumab

SC injections for 1 month

NA

Pain and severity of secretions, WBC, CRP, sialylated carbohydrate antigen KL-6, DLQI

Decrease in pain, cessation of purulent secretions, normalized WBC count, CRP levels, and KL-6 levels, improvement of DLQI after 18 months (2 to 0)

NA

NA

Kurokawa 2021 [58]

Case report

1

M

18

Insomnia, HS (Hurley stage I), NCA

Severe multiple painful, itchy hemorrhagic ulcerations, nodules, hypertrophic scar, and alopecia of the occipital area

6 years

Oral faropenem 600 mg/day and Saireito (Japanese herb) 8.1 g/day for 4 weeks

Adalimumab

160 mg of adalimumab on day 1, and subsequently, 80 mg every other week for 1 month

NA

Clinical signs and symptoms, hair regrowth, stabilization of the co-existing diseases

Reepithelialization of hemorrhagic ulceration, resulting in scar formation, a decrease in severe pain and itching, resolved insomnia, absence of the nodules on the occipital area, improvement of alopecia leading to hair growth, improvement of NCA on the face and nodules on the buttocks, control of HS (IHS4 reduced from 3 points to 0)

NA

NA

Frechet, 2021 [45]

Case series

9

M: 88.88%

33 ± 13

Obesity (44%), active smoking (44%). AC (66%), HS (66%), pilodinal sinus (11%), psoriasis (11%)

, HLA B27-negative spondylitis (11%)

NA

NA

Systemic antibiotics (78%), isotretinoin (67%), methotrexate (11%), disulone (11%), thalidomide (11%), oral corticosteroids (11%), apremilast (11%), canakinumab (11%), and tocilizumab (11%)

Infliximab and adalimumab

With a mean duration of 17 ± 16 months

Infliximab (89%) 5 mg/kg at weeks 0, 2, 6, and, every 8 weeks in 5 (63%) patients, and every 6 weeks in 3 (37%) patients, dosing was increased to 7.5 mg/kg in 1 patient

Adalimumab (11%) (40 mg every two weeks) without a washout period

Isotretinoin (33%), oral corticosteroids (33%), doxycycline (33%), and methotrexate (11%)

PGA, number of inflammatory nodules and abscesses, DLQI, treatment satisfaction index

The mean PGA score decreased from 4 ± 1 to 2 ± 1, the mean number of inflammatory nodules dropped from 9 ± 3 to 3 ± 4 (67% reduction), the mean number of abscesses decreased in 7/8 patients (89%) from

1.7 ± 1.06 to 0.2 ± 0.7 (78% reduction), the mean DLQI reduced from 27 ± 4 to 12 ± 8 (45% improvement), the mean treatment satisfaction index was 6.6 ± 1.6 out of 10, An increase in CPR and hyperleukocytosis persisted in one patient (75% reduction)

Retrobulbar optic neuritis leading to discontinuation of infliximab (n = 1)

Continuing the treatment for 17 ± 16 months

De Bedout, 2021 [65]

Case report

1

M

63

Acne vulgaris

Scarring alopecia with tender, fluctuant, purulent nodules

4 years

Doxycycline, trimethoprim-sulfamethoxazole, clindamycin, rifampin, and adalimumab, oral dapsone 12.5 mg daily with a gradual increase to 50 mg daily and concomitant intralesional triamcinolone 10 mg/cc

Secukinumab (IL-17 inhibitor)

150 mg weekly for 6 weeks (patient mistakenly took an extra loading dose) then monthly for 2 months

A total of 8 injections of 150 mg over three months

Dapsone 50 mg daily

Clinical signs and symptoms

Complete cessation of drainage and pain, regression of nodules

Eczematous reaction

The patient remained in remission at one-year follow-up

Alsantail, 2021 [32]

Case report

1

M

38

NA

Inflammatory, boggy, fluctuant nodules on the upper occiput with recurrent foul-smelling discharge. scalp punch biopsy: epidermal hyperkeratosis, neutrophilic infiltrate of the hair follicles and deep dermis, and focal areas with multinucleated giant cells and histocytes (foreign body giant cell reaction)

5 yearts

Several topical and systemic antibiotics (clindamycin, doxycycline, and amoxicillin/clavulanic acid), isotretinoin for 17 months, with dose escalation to 1 mg/kg (80 mg/day)

Adalimumab

80 mg on day 0, then 40 mg on day 7, and 40 mg weekly thereafter

NA

Clinical signs and symptoms, hair regrowth

Excellent response after 1 month, less pain, no more discharge, decreased swelling, and areas of hair regrowth after 2 months

NA

The patient continues to receive 40 mg of adalimumab weekly

Philips, 2020 [40]

Case series

1 (a total of 28 patients, 1 receiving ustekinumab)

NA

NA

IBD

NA

NA

Anti-TNFα

Ustekinumab (IL-12/23 inhibitor)

Topical therapies

Clinical signs and symptoms

No response to ustekinumab

NA

NA

Muzumdar, 2020 [66]

Case report

1

M

NA

HS, folliculitis, AC, and pyoderma gangrenosum

Multiple, painful, and tender fluctuant 1—2 cm nodules diffusely over the scalp, associated with patchy scarring alopecia

4 years

Methotrexate, minocycline, adalimumab 40 mg SC every week, hydroxychloroquine 200 mg BID, doxycycline 100 mg BID, prednisone 10 mg once daily, and intermittent topical clobetasol cream

Guselkumab

100 mg SC 4 weeks apart

for the first two doses, then every 8 weeks thereafter for 6 months

NA

Clinical signs and symptoms

Near-complete resolution of the scalp lesions associated with the resolution of all symptoms

Tolerable with no side effects

NA

Maxon, 2020 [53]

Case report

1

M

37

Extensive cystic acne

Bogginess, fluctuance, large, firm, skin-colored to erythematous nodules with overlying patches of scarring alopecia on the occipital scalp, several smaller erythematous nodules on the anterior frontal scalp

13 years

Serial intralesional corticosteroid injections, excision of scalp lesions, oral isotretinoin, intermittent oral antibiotics

Adalimumab

40 mg once weekly

NA

Clinical signs and symptoms, hair regrowth

Significant clinical improvement after 2 months, notable hair regrowth and reduction in bogginess and tenderness of the scalp after 6 months

NA

He continued therapy with adalimumab, but after 2 years of treatment, clinical improvement plateaued. He was subsequently placed back on the oral retinoid acitretin with additional improvement

Cautela, 2020 [39]

Case series

7

NA

NA

HS

NA

NA

NA

Adalimumab

160 mg at week 0, followed by 80 mg at week 2, then 40 mg from week 4 and thereafter every week

NA

Clinical signs and symptoms

Rapid reduction in clinical signs of inflammation and burden of disease

NA

NA

Takahashi, 2019 [5]

Case report

1

M

19

BMI = 31.1, HS

Multiple, soft subcutaneous nodules with oozing, purulent secretion from fistulas, patchy hair loss on the scalp, irregular skin surface caused by fistulas and scars resembling a so-called cutis verticis gyrata, multiple abscesses and fistulas reaching as deep as the skull bone in magnetic resonance imaging

5 years

Clarithromycin and zinc supplementation for 3 months

Adalimumab

SC injection of 80 mg on day 0, followed by 40 mg every other week, increased from 40 to 80 mg every other week at 3 months

NA

Clinical signs and symptoms, hair regrowth, stabilization of the co-existing diseases, laboratory tests

Improvement of pain and purulent secretion after 1 month, partial hair regrowth and diminished inflammatory skin lesions except for post-inflammatory hyperpigmentation and hypertrophic scars in axillae after 3 months, achieved HS clinical response, normalization of WBC counts and CRP level

NA

Continuing over 9 months with favorable response

Syed, 2018 [61]

Case report

1

M

31

Peptic ulcer disease status post partial gastrectomy, Crohn’s

disease

Multiple erythematous interconnecting plaques, some boggy with dried yellow crust on the frontal, parietal, and occipital scalp with scant purulent drainage

2 years

Antibiotic treatment

Infliximab (anti-TNFα)

Steroids

Clinical signs and symptoms, hair regrowth, stabilization of the co-existing diseases,

Complete remission of the skin disease and gastrointestinal symptoms

NA

NA

Sjerobabski Masnec, 2018 [54]

Case report

1

M

26

BMI: 35.8, smoking, HS (Hurley stage II), facial acne

Progressive patchy hair loss overlying inflammatory papules, pustules, yellow crusts, and tender, fluctuant, suppurative nodules (frontal scalp), several confluent conglomerates nodules, which discharged purulent secretion when pressed, fistulae, interconnecting sinuses, swelling of regional lymph nodes

NA

Isotretinoin at a dose of 0.64 mg/kg over 10 months, multiple antibiotics

Adalimumab

80 mg on days 0, 1, and 14 followed by 40 mg on day 28 and every week there- after

NA

Clinical signs and symptoms, stabilization of the co-existing diseases, DLQI

Significant improvement of all symptoms, reduced secretion, pain, and inflammatory changes on the scalp, absence of new nodules and sinus tracts in the bilateral axilla, inguinum, and pubic region, as well as clearing of facial acne, DLQI dropped significantly from 27 to 1

Tolerable with no adverse reactions

Continuing adalimumab 40 mg injections every week over 9 months with desireable response and tolerability

Mansouri, 2016 [55]

Case report

2

M

Pt1: 48

Pt2: 27

Pt1: HS, abnormal liver function tests (ALT twice the upper limit, GGT 37

times the upper limit of normal)

Pt2: NA

Pt1: malodorous, tender lesions on the scalp, perifollicular scaling, pustule scarring alopecia

Pt2: inflamed scalp, suppuration, and inflammatory papules, numerous perifollicular pustules, tender plaques with foul-smelling discharge, scarring alopecia on the scalp

Pt1: 20 years

Pt2: 4 years

Pt1: multiple antibiotics, zinc sulfate, dapsone, isotretinoin, systemic corticosteroids, surgical excision and drainage

Pt2: topical and systemic corticosteroids, antibiotics including dapsone, and isotretinoin

Pt1: adalimumab

80 mg on day 0, followed by 40 mg on day 7 and 40 mg every other week thereafter

Pt2: infliximab

5 mg kg 1 at weeks 0, 2 and 6, followed by 8-week intervals for 20 months

NA

Clinical signs and symptoms, DLQI

Pt1: reductions in inflammation and pain after 1 month, improvement in liver enzymes (ALT and alkaline phosphatase within the normal range), DLQI reduced significantly from 21 to 10 after 5 months, with marked reduction in discharge

Pt2: reduction of symptoms, inflammation and odour within 3 months of treatment, DLQI reduced from 18 to 6 after 12 months

NA

NA

Badaoui, 2016 [41]

Cohort study

1 (a total of 51 patients, 1 receiving infliximab)

M: 98%

NA

HS (n = 6, 12%), AC (n = 8, 16%), both AC and HS (n = 2.4%)

Subcutaneous nodules and abscesses located on the vertex (n = 25; 49%), diffuse over the entire scalp (n = 4, 9.8%)

Mild (2%), moderate (61%), and severe DCS (25%) A traumatic trigger (n = 5): hair shaving; neurosurgery for epilepsy or after wearing a helmet

Nodules: painful (n = 13, 25%) and itchy (n = 4, 8%)

The pattern of disease progression: chronic with progressive onset of lesions (n = 44; 86%), acute (n = 7, 14%)

34.3 (4–12) months

NA

Infliximab

NA

Clinical signs and symptoms

No improvement

NA

11.2 months of follow-up

Sand, 2015 [44]

Cohort study

2

M

NA

NA

Severe DCS

NA

Isotretinoin, dapsone, triamcinolone

Adalimumab

40 mg twice monthly

NA

Clinical signs and symptoms

1/2 (50%) response rate, an elderly man obtained total clearance of the disease within 3 months of therapy, whereas a young male patient did not respond to 6 months of therapy

No adverse events

NA

Martin-Garcia, 2015 [56]

Case report

1

M

30

NA

Scattered tender fluctuant nodules on the scalp, overlying alopecia

15 years

Intralesional triamcinolone, doxycycline, ciprofloxacin, isotretinoin

Adalimumab

80 mg on day 0, 40 mg on day 7, 40 mg every other week thereafter

NA

Clinical signs and symptoms

A significant decrease in pain and swelling of the lesions after 1 month, which progressively improved, complete clearance of

inflammatory lesions after 7 months

No adverse reaction

Continuing the treatment over 2 years

Prastou, 2014 [49]

Case report

1

M

49

Recurrent generalized folliculitis and furunculosis, microcytic anemia attributed to the beta-thalassemia trait, chronic abnormal cholestatic liver function tests, and hypertension

NA

NA

Oral antibiotics, intralesional and

oral steroids, isotretinoin, dapsone, intermittent courses of ciprofloxacin

over the previous 6 months, and bendroflumethiazide

Adalimumab

40 mg subcutaneously every fortnight

Ciprofloxacin and bendroflumethiazide

DLQI, clinical signs and symptoms

Improvement in scalp inflammation and discharge and reduction in DLQI from 21 to 10 at month 5

A tender lump on the

right lower leg new tender panniculitis

lesions on the lower limbs (after 2 months)

NA

Lim, 2013 [47]

Case series

1 (a total of 5 patients, 1 with DCS receiving anti-TNFα)

M

29

Sycoses barbae, AC, ankylosing spondylitis peripheral (LE) Achilles tendonitis

A few abscesses and multiple, crusted tender nodules with patchy alopecia over the vertex of the scalp

Pt1: 20 years

Pt1: rifampin and clindamycin

Adalimumab

40 mg SC every other week

Transretinoin cream and fluocinonide 0.05% cream, NSAID

Clinical signs and symptoms, stabilization of the co-existing diseases

Marked symptomatic improvement, resolution of Achilles tendonitis and knee synovitis, and his BASDAI score decreased from 5.2 to 1.2, asymptomatic and free of any skin lesions

NA

Asymptomatic, remained on adalimumab every 2 weeks

Wollina, 2012 [59]

Case report

1

M

30

Smoking, type 2

diabetes mellitus

inflammation, painful nodules on the scalp, malodorous discharge from enlarged pores, scarring alopecia and keloid-like scars, painful and swollen nuchal and submandibular lymph nodes

1 year

Rifampicin, isotretinoin, prednisolone, ibuprofen, metamizole, amitriptyline, minor surgery

Infliximab IV 5 mg/kg body weight at weeks 0, 2, and 6

Surgical management

Clinical signs and symptoms, CRP,

Significant reduction in inflammation, secretion, pain, and nodules, decreased CRP dropped (from 19.1 mg/L to 2.6 mg/L), complete disappearance of lymph node swelling, mood improvement

Psoriasiform exanthema induced by TNF-α inhibitor, which was completely managed by topical prednicarbate ointment

Nearly complete remission at

3 month follow-up

Navarini, 2010 [46]

Case series

3

M

Pt1: 27

Pt2: 29

Pt3: 30

Pt1: NA

Pt2: NA

Pt3: HS

Boggy and fluctuant infiltrates with purulent secretion

Pt1: pronounced inflammatory infiltrate, intermediate fibrosis and cicatrization

Pt2: detectable inflammatory infiltrate, no fibrosis, and cicatrization

Pt3: detectable inflammatory infiltrate, detectable fibrosis and cicatrization

Pt1: 1 year

Pt2: 4 years

Pt3: 7 years

Pt1: antibiotics

Pt2: antibiotics, tetracyclines, isotretinoin

Pt3: antibiotics, tetracyclines, levofloxacin, isotretinoin

Adalimumab

At a dose of 80 mg SC followed by a dose of 40 mg 1 week later and an additional 40 mg every second week

NA

SDAS, inflammatory infiltrate, fibrosis and cicatrization, biopsy

Pt1: SDAS dropped from 5 to 2, reduction in inflammatory infiltrate, amelioration of clinical symptoms, pronounced fibrosis, and cicatrization

Pt2: SDAS dropped from 8 to 2, remaining preexisting pathologic residual structures such as subcutaneous sinus tracts, amelioration of clinical symptoms, absence of fibrosis, and cicatrization

Pt3: SDAS dropped from 7 to 2, reduction in inflammatory infiltrate, amelioration of clinical symptoms, detectable fibrosis, and cicatrization

NA

Restarting adalimumab in Pt3 since disease activity returned within 4 weeks

Sukhatme, 2009 [57]

Case report

1

M

39

NA

Painful, tender fluctuant mass on posterior scalp

6 years

Multiple courses of antibiotics and intralesional triamcinolone injections, excision, oral isotretinoin

Adalimumab (anti-TNFα)

Two 40-mg SC injections for the first week, 40 mg for the second week, and then 40 mg every other week

NA

Clinical signs and symptoms, hair regrowth

After 2-months there were two slightly boggy flesh-colored nodules with hair growth with no erythema or purulent drainage

NA

At the 5-month follow-up, his lesions had cleared, and his hair was growing back normally

Brandt, 2008 [60]

Case report

1

M

24

NA

Pustules, tender nodules and sinus tracts on the scalp, scarring alopecia

Dermal sclerosis and fibrosis

4 years

Dapsone, doxycycline, ciprofloxacin and isotretinoin

Infliximab

5 mg/kg infused at 8-week intervals for 12 months, for a total of six infusions

NA

Hair regrowth, clinical signs and symptoms

Excellent response, with hair beginning to regrowth after the second infusion, continued

No adverse effects

One year after discontinuing infliximab, the hair regrowth was maintained with no signs of residual inflammation or relapse of the disease