BH13 Is this dissecting cellulitis of the scalp in a White child?

Abstract Dissecting cellulitis of the scalp (DCS) is characterized by recurrent pustules and sinus tract formation leading to scarring alopecia. Follicular obstruction a key pathogenic event associated with hidradenitis suppurativa acne conglobate. Commonly, DCS found in adult men Afro-Caribbean descent (Arneja J, Vashi C, Gursel E, Lelli J. Management fulminant dissecting pediatric population: case report literature review. Can J Plast Surg 2007; 15:211–14). We describe rare White child who presented features suggestive DCS. An 11-year-old boy was referred 2-year history patches alopecia affecting occipital which initially treated as tinea capitis antifungal creams, but this ineffective. On examination, there diffuse, boggy subcutaneous swelling scarring, overlying erythema on scalp. A course erythromycin oral terbinafine showed partial response affected areas, although subsequent new were noted similar manifestation bogginess erythema. Systemic blood tests skin scrapings unremarkable. While continuing erythromycin, he counselled for isotretinoin referral tertiary centre has been made guide further management. Paediatric encompasses congenital acquired causes (Imhof R, Cantwell H, Proffer S et al. The spectrum alopecia: retrospective review 27 patients seen at Mayo Clinic. Pediatr Dermatol 2021; 38:580–4). differential diagnosis our patient included causing irreversible alopecia, being aware phenomenon late presentations delayed treatment vital. Other differentials are discoid lupus cutaneous morphoea. However, clinical more keeping DCS, scarcely reported paediatric literature. Histological confirmation not always practical children, follow-up assess disease prudent. Importantly, discussion permanent hair loss parent remains challenging, clinicians should be psychosocial impact.