Surgical management of dissecting cellulitis of the scalp: a narrative review of techniques, patient selection, and integration with medical therapy

Abstract

OBJECTIVE: To summarize surgical objectives, indications, technical principles, limitations and reconstructive considerations for dissecting cellulitis of the scalp (DCS), and explicitly distinguish DCS‑specific evidence from data extrapolated from hidradenitis suppurativa (HS). METHODS: This narrative review searched PubMed/MEDLINE up to July 2026. Twenty‑four publications focusing on DCS surgical management were included for narrative synthesis. Formal systematic‑review procedures such as PRISMA screening, risk‑of‑bias assessment and meta‑analysis were not performed. RESULTS: Simple drainage only achieves temporary abscess decompression without durable disease control. Deroofing and skin‑tissue‑sparing excision may preserve hair‑bearing scalp for selected tunnel‑forming lesions. Local excision suits circumscribed refractory disease, while wide excision with graft or flap reconstruction provides the most durable local control for extensive medically refractory DCS at the cost of permanent alopecia and higher operative morbidity. Much available surgical evidence is indirectly extrapolated from HS. CONCLUSION: Individualized multimodal strategies integrating surgery, disease mapping, patient priorities and ongoing medical therapy are essential. Standardized outcome definitions and prospective comparative studies are urgently required to advance DCS surgical care.

The authors' abstract, as published at the source. Journal of Dermatological Treatment, 2026 · DOI ↗