Exploring the Efficacy and Safety of Interleukin-23 Inhibitors in Dissecting Cellulitis of the Scalp: A Comprehensive Review

Background

Dissecting cellulitis of the scalp (DCS), also known as perifolliculitis capitis abscedens et suffodiens or Hoffmann disease, is a rare chronic inflammatory scalp condition with an unknown etiology. The US Food and Drug Administration (FDA) has recently approved multiple interleukin-23 (IL-23) inhibitors for chronic-plaque psoriasis, and their off-label use has shown promise in treating various dermatological conditions, including DCS. This review assesses the efficacy and safety of IL-23 inhibitors for DCS, aiming to support potential FDA approval for severe refractory cases.

Methods

A comprehensive literature search was conducted in February 2024 using MEDLINE, PUBMED, and Google Scholar with the keywords “Dissecting cellulitis,” “DCS,” “Interleukin-23 inhibitors,” “IL-23,” and “Biologics.” The search focused on identifying studies reporting the use of IL-23 inhibitors in DCS treatment.

Results

The search identified five cases where IL-23 inhibitors were used to treat DCS. All patients were male, aged 17–65 years, with multiple comorbidities in four cases, primarily hidradenitis suppurativa and acne conglobata. The IL-23 inhibitors Risankizumab, Guselkumab, and Tildrakizumab were used, resulting in significant clinical improvement, near-complete remission, and hair regrowth. Additionally, psychosocial improvements were noted in two cases, with no reported adverse effects.

Conclusion

IL-23 inhibitors have shown remarkable efficacy in treating severe DCS, with significant clinical and psychosocial improvements and a favorable safety profile. These findings support the consideration of FDA approval for IL-23 inhibitors as a treatment option for refractory DCS cases, offering hope for patients with this challenging condition.