Metabolic and Psychiatric Comorbidities in Dissecting Cellulitis of the Scalp: A Retrospective Cohort Study and Scoping Review.

introductionDissecting cellulitis of the scalp (DCS) is a chronic inflammatory disorder traditionally described as affecting young Black men; however, its broader epidemiology and comorbidity profile remain incompletely characterized. We aimed to evaluate demographic characteristics and systemic comorbidities associated with DCS.

methodsWe performed a retrospective cohort study of patients diagnosed with DCS across the Mass General Brigham network from 1 January 2015 to 1 February 2025. Demographic characteristics and comorbidities, including metabolic, psychiatric, autoimmune, and smoking history, were extracted. In parallel, a structured scoping review of PubMed was performed to identify cohort studies reporting demographic and clinical data in DCS.

resultsTwenty-nine patients met inclusion criteria (89.7% male; mean age 35.9 ± 10.2 years), with diverse racial representation. Nearly half had at least one additional disorder on the follicular occlusion spectrum, and 82.8% had at least one metabolic dysfunction-associated comorbidity. Psychiatric diagnoses were present in 41.4% of patients. Seventeen published cohorts comprising 710 patients were identified. Across studies, DCS consistently demonstrated strong male predominance and heterogeneous racial distribution. Overweight or obese body mass index and metabolic comorbidities were frequently reported, while psychiatric comorbidity was underreported.

conclusionsThese findings challenge the conventional characterization of DCS as a disorder primarily of Black men and instead emphasize global heterogeneity. We instead support an association of DCS with male sex, metabolic dysfunction associated comorbidities, and psychiatric comorbidities. Limitations include the retrospective design, small institutional sample size, absence of control group, use of a single database, and heterogeneity in reporting across published cohorts.