Use of Skin Ultrasound Imaging in Dissecting Cellulitis: Two Cases and Review

Keywords: Cellulitis/diagnostic imaging, Folliculitis, Scalp Dermatoses, Ultrasonography


Cellulitis dissecans and folliculitis decalvans may present, in early stages, a similar clinical picture. This article presents the ultrasound findings of dissecting cellulitis that help in the diagnosis and treatment. Ultrasound is not a substitute for observation, trichoscopy and histopathology, but it may help with diagnosis. In the active phase, non-encapsulated ovoid lesions of relatively well-defined edges with hypoechogenic content, which communicate with the dermis through the enlarged bulbs of hair follicles, were observed. It allows distinction from folliculitis decalvans and from a trichilemmal cyst (in case of single or few lesions) and, by allowing the assessment of inflammation when combined with color Doppler, it can monitor inflammation and therapeutic response. The authors share 2 illustrative clinical cases and a review of the literature on the topic.


Download data is not yet available.


Bernárdez C, Molina-Ruiz A, Requena L. Histopatología de las alopecias. Parte II: alopecias cicatriciales. Actas Dermo-Sifiliográficas. 2015;106(4):260-70.

Fabris MR, Melo CP, Melo DF. Folliculitis decalvans: the use of dermatoscopy as an auxiliary tool in clinical diagnosis. Anais brasileiros de dermatologia. 2013;88(5):814-6.

Wortsman X, Wortsman J. Clinical usefulness of variable-frequency ultrasound in localized lesions of the skin. Journal of the American Academy of Dermatology. 2010;62(2):247-56.

Fernandes NC, Magalhães TC, Quintella DC, Cuzzi T. Foliculite supurativa crônica de couro cabeludo: desafio terapêutico. 2018.

Bolduc C, Sperling LC, Shapiro J. Primary cicatricial alopecia: Other lymphocytic primary cicatricial alopecias and neutrophilic and mixed primary cicatricial alopecias. Journal of the American Academy of Dermatology. 2016;75(6):1101-17.

Powell J, Dawber R, Gatter K. Folliculitis decalvans including tufted folliculitis: clinical, histological and therapeutic findings. The British journal of dermatology. 1999;140(2):328-33.

Jahns AC, Lundskog B, Berg J, Jonsson R, McDowell A, Patrick S, et al. Microbiology of folliculitis: a histological study of 39 cases. Apmis. 2014;122(1):25-32.

Matard B, Donay JL, Resche‐Rigon M, Tristan A, Farhi D, Rousseau C, et al. Folliculitis decalvans is characterized by a persistent, abnormal subepidermal microbiota. Experimental dermatology. 2019.

Gaopande VL, Kulkarni MM, Joshi AR, Dhande AN. Perifolliculitis capitis abscedens et suffodiens in a 7 years male: A case report with review of literature. International journal of trichology. 2015;7(4):173.

Navarini AA, Trüeb RM. 3 cases of dissecting cellulitis of the scalp treated with adalimumab: control of inflammation within residual structural disease. Archives of dermatology. 2010;146(5):517-20.

Scheinfeld N. Dissecting cellulitis (Perifolliculitis Capitis Abscedens et Suffodiens): a comprehensive review focusing on new treatments and findings of the last decade with commentary comparing the therapies and causes of dissecting cellulitis to hidradenitis suppura. Dermatology online journal. 2014;20(5).

Köse ÖK, Güleç AT. Clinical evaluation of alopecias using a handheld dermatoscope. Journal of the American Academy of Dermatology. 2012;67(2):206-14.

Rudnicka L, Olszewska M, Rakowska A, Slowinska M. Trichoscopy update 2011. Journal of dermatological case reports. 2011;5(4):82.

Tosti A, Torres F, Miteva M. Dermoscopy of early dissecting cellulitis of the scalp simulates alopecia areata. Actas dermo-sifiliograficas. 2013;104(1):92.

Olga Warszawik M. Trichoscopy of cicatricial alopecia. Journal of Drugs in Dermatology. 2012;11(6):753-8.

Sperling LC. Scarring alopecia and the dermatopathologist. Journal of cutaneous pathology. 2001;28(7):333-42.

Barcaui EdO, Carvalho ACP, Piñeiro-Maceira J, Barcaui CB, Moraes H. Estudo da anatomia cutânea com ultrassom de alta frequência (22 MHz) e sua correlação histológica. Radiologia Brasileira. 2015;48(5):324-9.

de Vilhena Diniz F, Sameshima YT, de Oliveira Cyrineu F, Kim MH, Quadros MS, Neto MJF, et al. Ultrassonografia nas lesões do couro cabeludo pediátrico.Rev.Imagem.2010;32:53-60.

Wortsman X, Roustan G, Martorell A. Ecotomografía Doppler color de cuero cabelludo y pelo. Actas Dermo-Sifiliográficas. 2015;106:67-75.

Wortsman X, Wortsman J, Matsuoka L, Saavedra T, Mardones F, Saavedra D, et al. Sonography in pathologies of scalp and hair. The British journal of radiology. 2012;85(1013):647-55.

Cataldo-Cerda K, Wortsman X. Dissecting cellulitis of the scalp early diagnosed by color doppler ultrasound. International journal of trichology. 2017;9(4):147.

Martorell A, Alfageme Roldán F, Vilarrasa Rull E, Ruiz‐Villaverde R, Romaní De Gabriel J, García Martínez F, et al. Ultrasound as a diagnostic and management tool in hidradenitis suppurativa patients: a multicentre study. Journal of the European Academy of Dermatology and Venereology. 2019;33(11):2137-42.

Wortsman X. Diagnosis and treatment of hidradenitis suppurativa. 2018.

Shavit E, Alavi A, Bechara FG, Bennett RG, Bourcier M, Cibotti R, et al. Proceeding report of the Second Symposium on Hidradenitis Suppurativa Advances (SHSA) 2017. Experimental dermatology. 2019;28(1):94-103.

Roldán FA. Elastografía en dermatología. Actas Dermo-Sifiliográficas. 2016;107(8):652-60.

Garra BS. Elastography: current status, future prospects, and making it work for you. Ultrasound quarterly. 2011;27(3):177-86.

Kaya İslamoğlu ZG, Uysal E. A preliminary study on ultrasound techniques applied to cicatricial alopecia. Skin Research and Technology. 2019;25(6):810-4.

How to Cite
Aline, A., Mendes Bastos, P., Miguel, D., & Oliveira-Soares, R. (2021). Use of Skin Ultrasound Imaging in Dissecting Cellulitis: Two Cases and Review. Journal of the Portuguese Society of Dermatology and Venereology, 79(1), 61-65.
Case Reports