Biologic Therapies and Small-Molecule Inhibitors for Dissecting Cellulitis of the Scalp: A Systematic Review

Dissecting cellulitis of the scalp (DCS) is a challenging condition to treat due to the lack of specific guidelines. This systematic review analyzed 46 studies involving 125 patients to evaluate the efficacy and safety of biologic therapies and small-molecule inhibitors for DCS. Tumor necrosis factor alpha (TNFα) inhibitors, particularly adalimumab and infliximab, were the most frequently used and showed response rates over 80%. Interleukin (IL)-17 and IL-23 inhibitors also showed promise in refractory cases, while JAK inhibitors were identified as alternative options. The adverse event rate was 8.3%, mostly mild or moderate. The findings suggest that advanced therapies, especially TNFα inhibitors, are effective and well-tolerated for severe or refractory DCS. Early treatment initiation may alter the disease course and prevent scarring alopecia, though further prospective studies are needed to confirm this potential benefit.