Heidari Nazila, Ghannadzadeh Kermani Pour Rad, Farshbafnadi Melina, Heidari Amirhossein, Ghane Yekta
School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Orphanet J Rare Dis. 2025 May 18;20(1):236. doi: 10.1186/s13023-025-03720-5.
Dissecting cellulitis of the scalp (DCS) is a type of neutrophilic scarring alopecia identified by the development of folliculitis with clusters of perifollicular pustules and then progresses to abscesses and intercommunicating sinus formation. In the absence of evidence-based guidelines, the treatment of DCS remains a therapeutic challenge. Our study aimed to assess the safety and efficacy of biologics, including tumor necrosis factor-α (TNF-α) blockers, anti-interleukins (ILs), and small molecule inhibitors, including Janus kinase (JAK) inhibitors and phosphodiesterase inhibitors in treating DCS.
PubMed/Medline, Scopus, and Ovid Embase databases were systematically searched until February 4th, 2024. Study selection was restricted to case reports, case series, cohort studies, and clinical trials published in English-language. NIH and Murad et al.'s quality assessment tools were utilized for critical appraisal.
A total of 34 articles involving 81 patients met the inclusion criteria. The immunomodulators studied for the treatment of DCS include adalimumab, infliximab, certolizumab pegol, ustekinumab, secukinumab, guselkumab, risankizumab, tildrakizumab, apremilast, upadacitinib, and baricitinib. Our findings implied that TNF-α blockers and IL inhibitors were associated with clinical improvement in most individuals with moderate-to-severe DCS, especially in those who had failed earlier treatments. Moreover, certolizumab pegol could be a safe option for DCS in pregnancy. In addition, the prescription of small molecule inhibitors, including JAK inhibitors and apremilast in DCS patients, demonstrated a significant amelioration in DCS symptoms with a desirable safety profile. Nevertheless, the available data was limited, warranting further investigation. Besides, all aforementioned immunomodulators are still debated for their effectiveness on hair regrowth and reversing the scarring process.
The application of immunomodulators in treating DCS was associated with satisfactory outcomes, although there is still a need to assess the long-term safety and effectiveness of these therapeutic agents in preventing disease progression and new flare-ups.
头皮穿掘性蜂窝织炎（DCS）是一种中性粒细胞性瘢痕性脱发，其特征为出现伴有毛囊周围脓疱簇的毛囊炎，随后发展为脓肿和相互连通的窦道形成。在缺乏循证指南的情况下，DCS的治疗仍然是一项治疗挑战。我们的研究旨在评估生物制剂的安全性和有效性，这些生物制剂包括肿瘤坏死因子-α（TNF-α）阻滞剂、抗白细胞介素（IL）以及小分子抑制剂，如 Janus激酶（JAK）抑制剂和磷酸二酯酶抑制剂，用于治疗DCS。
系统检索PubMed/Medline、Scopus和Ovid Embase数据库直至2024年2月4日。研究选择仅限于以英文发表的病例报告、病例系列、队列研究和临床试验。使用美国国立卫生研究院（NIH）和穆拉德等人的质量评估工具进行严格评价。
共有34篇涉及81例患者的文章符合纳入标准。研究用于治疗DCS的免疫调节剂包括阿达木单抗、英夫利昔单抗、赛妥珠单抗、乌司奴单抗、司库奇尤单抗、古塞库单抗、瑞莎珠单抗、替拉珠单抗、阿普米拉斯、乌帕替尼和巴瑞替尼。我们的研究结果表明，TNF-α阻滞剂和IL抑制剂与大多数中重度DCS患者的临床改善相关，尤其是那些早期治疗失败的患者。此外，赛妥珠单抗可能是孕期DCS的安全选择。此外，在DCS患者中使用小分子抑制剂，如JAK抑制剂和阿普米拉斯，显示出DCS症状有显著改善且安全性良好。然而，现有数据有限，需要进一步研究。此外，所有上述免疫调节剂在促进头发生长和逆转瘢痕形成过程中的有效性仍存在争议。
免疫调节剂在治疗DCS方面具有令人满意的效果，尽管仍需要评估这些治疗药物在预防疾病进展和新发作方面的长期安全性和有效性。
