Hidradenitis suppurativa (HS) rarely affects the scalp. It’s more often found in areas where skin rubs together, like the armpits, under the breasts, inner thighs, or groin. That said, scalp involvement can happen, though it’s uncommon.

Sometimes, hidradenitis suppurativa on the scalp is misdiagnosed as a different condition called dissecting cellulitis of the scalp (DCS). These two conditions can look similar, and both fall under a group of diseases known as follicular occlusion syndromes. These conditions involve hair follicles that become blocked, inflamed, and can rupture, leading to painful skin symptoms.

It’s possible to have more than one type of follicular occlusion syndrome at the same time. Many of the symptoms and treatments overlap. Here’s what you should know if your scalp is developing HS symptoms like painful cysts, nodules, and abscesses.

What Is Dissecting Cellulitis of the Scalp?

Dissecting cellulitis of the scalp is a chronic inflammatory skin condition that shares many features with HS. Some researchers consider it closely related to HS, though it is considered a distinct diagnosis that affects only the scalp.

Because the scalp has a different density of sweat glands and hair follicles, DCS can look a bit different from how HS appears on other parts of the body.

Common Symptoms

Unlike HS, DCS is more common in men than women, according to the journal Clinics in Dermatology. However, the two conditions share other risk factors. African Americans and people who have a body mass index (BMI) of 30 or higher are more likely to develop HS and DCS.

DCS often begins the scalp starts at the top of the head and spreads to the back. It begins with swollen, tender areas that may fill with pus and ooze. In severe cases, it covers the entire scalp. Abscesses and tunneling can develop, leading to hair loss and scars. Hair doesn’t grow back on scarred areas, so getting a handle on the condition as early as possible is important.

Management of Hidradenitis Suppurativa on the Scalp

Whether you’re diagnosed with scalp HS or DCS, the treatment options are the same. Your healthcare provider will base treatment on your specific symptoms and medical history.

Topicals and Oral Medications

Your dermatologist may recommend topical steroids or antimicrobials to reduce inflammation and kill bacteria in the affected areas. These medicated products come in different forms, like a cream, foam, spray, gel, or lotion.

Depending on your hairstyle, you may find one formulation works better than another. If you have long hair, you might want to apply treatments at bedtime or wear your hair in braids or under a hat to help keep it from looking greasy or flaky. Washing your hair with antiseptic shampoo and avoiding oil-based hair products can help reduce scalp flare-ups.

You may also need to take pills by mouth to help clear up HS flare-ups on the scalp. Some different options include:

• Antibiotics or dapsone (an antibacterial medicine)
• High-dose zinc supplements
• Retinoids, like isotretinoin and acitretin
• Steroids for short-term treatment

Long-Term Treatments

Injectable biologic drugs — medications made from living cells — are used to lower inflammation and treat HS symptoms throughout the body. Biologics are a long-term treatment option for people whose symptoms don’t clear up with other treatments.

You can also discuss light therapy, hormone therapy, surgery, or laser hair removal as possible treatments. If you have hair loss from scarring or laser treatments, you may choose to wear a wig. In some cases, your health insurance can help cover the cost.

Talk With Others Who Understand

On myHSteam, the social network for people and their loved ones living with hidradenitis suppurativa, more than 46,000 members come together to ask questions, give advice, and share their stories with others who understand life with this challenging skin condition.

Have you dealt with skin lesions on the scalp? If so, how do they affect your quality of life? Share your experience in the comments below, or start a conversation by posting on your Activities page.