Surgical interventions combined with photodynamic therapy in the treatment of Perifolliculitis Capitis Abscendens et Suffodiens: Report of 5 cases

Perifolliculitis capitis abscedens et suffodiens (PCAS), also known as dissecting cellulitis of the scalp (DCS), is a rare, chronic, suppurative inflammatory disease of the scalp which may evolve into cicatricial alopecia. Its refractory nature has a detrimental impact on patients' quality of life. Here, we report five cases of PCAS treated with 5% 5-aminolevulinic acid-based photodynamic therapy (ALA-PDT), prior to which different methods of surgical intervention were given. The surgical interventions were under local anesthesia. In general, all surgical interventions, pretreatments and PDT were well tolerated. 4 patients showed complete clearance of lesions and 1 patient attained significant improvement of symptoms 1 month after treatment. This suggested that surgical interventions, combined with topical ALA-PDT could be an effective, minimally-invasive, and safe alternative for PCAS, especially for cases recalcitrant to other conventional therapies.