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Zagelbaum Ward NK, Jun JA, Vecerek N, Donaldson M, Quismorio FP. Dissecting cellulitis of the scalp associated with peripheral and axial spondyloarthritis: report of a case and review of the literature. Clin Rheumatol 2022; 41:2553-2560. [PMID: 35460009 DOI: 10.1007/s10067-022-06128-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
Abstract
Dissecting cellulitis of the scalp (DCS) is a rare, primary neutrophilic cicatricial alopecia of unknown etiology. The disease follows a chronic, relapsing, and remitting course which may ultimately lead to scar formation and alopecia. The association of seronegative peripheral and/or axial spondyloarthritis in patients with hidradenitis suppurativa (HS) and acne conglobata (AC) is well established. However, the occurrence of spondyloarthropathy in patients with either isolated or combined DCS is relatively rare and therefore underrecognized by clinicians. We report a patient with DCS with inflammatory peripheral arthritis and asymptomatic radiographic sacroiliitis. Using PubMed, Ovid, and Google scholar, we searched for case reports of inflammatory arthritis in HS, AC, and DCS in the English literature from 1982 to present. We identified 12 patients with DCS who had associated spondyloarthropathy with adequate clinical details for a systematic analysis. We outline key clinical features, radiographic findings, and treatment utilized for these patients. Seronegative axial and peripheral spondyloarthritis may occur in the setting of isolated DCS as well with concomitant HS and AC. The inflammatory arthritis often develops during acute flares of the cutaneous disease. Choosing optimal drug therapy may be challenging. Current options include anti-TNF-α medications, which have been reported to be effective for both the cutaneous lesions and the associated spondyloarthritis. The complex pathophysiology of the conditions that comprise the follicular occlusion triad warrants further research into the potential role of additional biologic agents.
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Affiliation(s)
- Nicole K Zagelbaum Ward
- Division of Rheumatology, Department of Medicine, and Division of Dermatology, Keck School of Medicine, University of Southern California and Los Angeles County, Los Angeles, CA, USA. .,Division of Rheumatology, Department of Medicine, Keck School of Medicine, University of Southern California and Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA.
| | - Jenny Ann Jun
- Division of Rheumatology, Department of Medicine, and Division of Dermatology, Keck School of Medicine, University of Southern California and Los Angeles County, Los Angeles, CA, USA.,Division of Rheumatology, Department of Medicine, Keck School of Medicine, University of Southern California and Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA
| | - Natalia Vecerek
- Division of Rheumatology, Department of Medicine, and Division of Dermatology, Keck School of Medicine, University of Southern California and Los Angeles County, Los Angeles, CA, USA.,Division of Rheumatology, Department of Medicine, Keck School of Medicine, University of Southern California and Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA
| | - Marie Donaldson
- Division of Rheumatology, Department of Medicine, and Division of Dermatology, Keck School of Medicine, University of Southern California and Los Angeles County, Los Angeles, CA, USA.,Division of Rheumatology, Department of Medicine, Keck School of Medicine, University of Southern California and Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA
| | - Francisco P Quismorio
- Division of Rheumatology, Department of Medicine, and Division of Dermatology, Keck School of Medicine, University of Southern California and Los Angeles County, Los Angeles, CA, USA.,Division of Rheumatology, Department of Medicine, Keck School of Medicine, University of Southern California and Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA
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Guo W, Zhu C, Stevens G, Silverstein D. Analyzing the Efficacy of Isotretinoin in Treating Dissecting Cellulitis: A Literature Review and Meta-Analysis. Drugs R D 2021; 21:29-37. [PMID: 33387328 PMCID: PMC7937584 DOI: 10.1007/s40268-020-00335-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Dissecting cellulitis of the scalp is a primary scarring alopecia. Isotretinoin is commonly referenced in the literature as a treatment for dissecting cellulitis. The objective of this article was to conduct a review and meta-analysis to assess the efficacy of isotretinoin for treating dissecting cellulitis of the scalp. METHODS The following databases were searched for articles prior to 23 June, 2019: PubMed, Embase, Cochrane Central, CINAHL, and Web of Science. Multi-patient studies (more than three) that reported on the administration of isotretinoin for dissecting cellulitis were included. A pooled meta-analysis for improvement of disease burden after isotretinoin administration in patients with dissecting cellulitis of the scalp was performed. A fixed-effects model was used. RESULTS Five articles were ultimately used for the quantitative meta-analysis. The overall efficacy rate of isotretinoin in treating dissecting cellulitis of the scalp was estimated to be 0.9 with a 95% confidence interval (0.81-0.97). The sensitivity analysis suggested that the overall efficacy is still very high, with a range of 0.83-0.94. Recurrence was seen in 24% (6/25) of patients. Common associated diseases amongst patients with dissecting cellulitis of the scalp were acne conglobata 20% (30/151) and hidradenitis suppurativa 19% (11/72). CONCLUSIONS Isotretinoin is an effective treatment for improving symptoms of dissecting cellulitis of the scalp. Disease recurrence is a common finding for those who undergo successful treatment.
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Affiliation(s)
- William Guo
- Renaissance School of Medicine at Stony Brook University, 1320 Stony Brook Rd., Building F, Suite 200, Stony Brook, NY, 11790, USA.
| | - Chencan Zhu
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA
| | - Gregg Stevens
- Health Sciences Library at Stony Brook University, Stony Brook, NY, USA
| | - David Silverstein
- Department of Dermatology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
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Chu S, Michelle L, Ekelem C, Sung CT, Rojek N, Mesinkovska NA. Oral isotretinoin for the treatment of dermatologic conditions other than acne: a systematic review and discussion of future directions. Arch Dermatol Res 2020; 313:391-430. [PMID: 33151346 DOI: 10.1007/s00403-020-02152-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/29/2020] [Accepted: 10/09/2020] [Indexed: 11/28/2022]
Abstract
While isotretinoin has been the gold-standard of therapy for severe acne since its approval in 1982, its anti-inflammatory properties makes it a potentially applicable and versatile therapy for a wide variety of dermatologic conditions yet to be explored. This systematic review comprehensively recounts the success of oral isotretinoin in non-acne cutaneous diseases and provide insight into future directions of isotretinoin utility. A systematic literature review was performed using PubMed. Search terms included "isotretinoin" OR "accutane" AND "skin" OR "dermatology" OR "hair" OR "nails" OR "rosacea" OR "psoriasis" OR "pityriasis rubra pilaris" OR "condyloma acuminata" OR "granuloma annulare" OR "darier's disease" OR "non-melanoma skin cancer" OR "frontal fibrosing alopecia" OR "cutaneous lupus erythematosus" OR "hidradenitis suppurativa" OR "photodamaged skin" OR "skin aging" OR "wart" OR "flat warts" OR "plane warts" OR "lichen planus" OR "dissecting cellulitis" OR "folliculitis decalvans" OR "sebaceous hyperplasia" OR "cutaneous t-cell lymphoma" OR "mycosis fungoides." A total of 169 studies discuss the use of oral isotretinoin for 16 non-acne dermatologic conditions, the most common being non-melanoma skin cancers (0.2-8.2 mg/kg/day), cutaneous T-cell lymphomas (0.5-2 mg/kg/day), and rosacea (0.22-1 mg/kg/day). Inflammatory conditions such as rosacea, granuloma annulare, and hidradenitis suppurativa benefit from lower oral isotretinoin dosage of 0.3-1 mg/kg/day, whereas, hyperkeratotic diseases such as psoriasis and pityriasis rubra pilaris, consistently respond better to higher dosages of up to 2-4 mg/kg/day for lesion clearance. Recurrence of disease following discontinuation of isotretinoin have been reported for rosacea, psoriasis, granuloma annulare, Darier's disease, dissecting cellulitis, and non-melanoma skin cancers. Disease exacerbation was reported in some patients with hidradenitis suppurativa. Off-label isotretinoin is an effective treatment choice for dermatological conditions beyond acne. Further prospective, randomized human trials are needed to clarify when and how to prescribe off-label isotretinoin for maximum efficacy and safety.
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Affiliation(s)
- Sherman Chu
- College of Osteopathic Medicine of the Pacific, Northwest, Western University of Health Sciences, 200 Mullins Dr., Lebanon, OR, 97355, USA. .,Department of Dermatology, University of California, Irvine, Irvine, CA, 92697, USA.
| | - Lauren Michelle
- Department of Dermatology, University of California, Irvine, Irvine, CA, 92697, USA
| | - Chloe Ekelem
- Department of Dermatology, University of California, Irvine, Irvine, CA, 92697, USA
| | - Calvin T Sung
- Department of Dermatology, University of California, Irvine, Irvine, CA, 92697, USA
| | - Nathan Rojek
- Department of Dermatology, University of California, Irvine, Irvine, CA, 92697, USA
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