Can Dissecting Cellulitis be A Side Effects of FUE Hair Transplants?

Case of Dissecting Cellulitis as a Complication of FUE Hair Transplantation

Authors form Italy report a case of a patient developing DSC after FUE hair transplantation.

The patient came to medical attention with a history of nodulocystic lesions for about 10 years. These lesions started about 2 months after an FUE hair transplant.  

The patient had no history of scalp folliculitis. The patient had a history of fluctuating cysts communicating with each other via fistulas draining pus and blood. The patient reported intense pain. The lesions were repeatedly excised in the past but unfortunately new lesions kept reforming in new areas of the occipital and vertex area.

Examination by the authors showed numerous cyst-induced scarring in the donor area. Biopsy of the lesions suggested DSC.

The authors speculate that the mechanical extraction of follicular units was the trigger in this patient’s disease. The authors further propose there was immunological dysfunction and alteration of scalp microbiota in a context of some sort of predisposition to the follicular occlusion. The authors call on the surgical community to continue to study this rare phenomenon and report cases.

Comment

This is interesting and adds another condition to the list of diseases that can occur in the donor area post op. It’s possible to see lichen planopilaris, chronic folliculitis and here dissecting cellulitis.

It’s not clear why this occurred to this patient but the authors give a pretty convincing story. One wonders if there is any evidence of hidradenitis suppurativa, or pilonidal cysts in the story. These can be found with DSC in a small proportion of patients.

There can be mimics of DSC like chronic infections, tinea capitis and lymphoma so a biopsy always makes sense in these challenging conditions. There is not a whole lot to support these entities in the differential diagnosis. Culture can be helpful too as the histological findings of DSC are somewhat non-specific. I often send a piece of the biopsy off for deep fungal, atypical microbacterial and other infectious etiologies.

Reference

Genco L et al. Perifolliculitis Capitis Abscedens et Suffodiens after Follicular Unit Transplantation: A Case Report. Skin Appendage Disord. 2023 Jan;9(1):73-75.